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When called to guide a patient through an illness the physician should 
be constantly a watchman, and a therapeutist only when necessity arises. 

A good physician is one who, having pure drugs, knows when to use them, 
how to use them, and, equally important, when not to use them. 

When a physician gives a drug and the patient improves, care should be 
taken not to ascribe all the good results to the remedy employed. Nature must 
be given credit for a large part of the improvement. 



A TEXTBOOK 



PRACTICAL THERAPEUTICS, 



WITH ESPECIAL REFERENCE TO THE 



APPLICATION OF REMEDIAL MEASURES TO DISEASE 



AND THEIR 



EMPLOYMENT UPON A RATIONAL BASIS. 



BY 

HOBART AMORY HARE, M.D., B.Sc, 

PROFESSOR OF THERAPEUTICS AND MATERIA MEDICA IN THE JEFFERSON MEDICAL COLLEGE OF 
PHILADELPHIA; PHYSICIAN TO THE JEFFERSON MEDICAL COLLEGE HOSPITAL; ONE-TIME 
CLINICAL PROFESSOR OF DISEASES OF CHILDREN IN THE UNIVERSITY OF PENN- 
SYLVANIA; LAUREATE OF THE ROYAL ACADEMY OF MEDICINE IN BEL- 
GIUM, OF THE MEDICAL SOCIETY OF LONDON - , MEMBER OF 
THE COMMITTEE OF REVISION OF THE UNITED 
STATES PHARMACOPOEIA OF 1905. 



ELEVENTH EDITION, ENLARGED, THOROUGHLY REVISED AND LARGELY RE-WRITTEN. 

ILLUSTRATED WITH 113 ENGRAVINGS AND 4 COLORED PLATES. 




LEA BKOTHEKS & CO., 
PHILADELPHIA AND NEW YORK. 

1905. 



LIBRARY of 


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Copyright, 1905, by 
LEA BROTHERS & CO. 



Authority to use for comment the Pharmacopoeia of the United States 
of America (Eighth Decennial Revision), in this volume, has been granted 
by the Board of Trustees of the United States Pharmacopoeial Convention; 
which Board of Trustees is in no way responsible for the accuracy of any 
translations of the Official Weights and Measures, or for any statement as 
to strength of Official Preparations. 



DORNAN, PRINTER, 
PHILADELPHIA. 



PREFACE TO ELEVENTH EDITION. 



When the first edition of this book appeared, fifteen years ago, 
the author stated in the preface that his object was to provide the 
physician or undergraduate student of medicine with a reliable guide 
in the study of Therapeutics, or the application of remedial measures 
for the cure of disease. It was written because, in the belief of the 
author, most of the text-books on this subject treat of it as if the 
student were already a skilled physician or experimental pharmacolo- 
gist. As a consequence, two classes of undergraduate readers exist. 
One finds that the mixture of science and empiricism is too difficult for 
him to fathom, and is hopelessly confused; the other simply learns the 
remedies and doses by heart and gives drugs with little idea as to what 
they are to do. Further than this, the physician is often at a loss to 
decide when a remedy is indicated, even though his theoretical knowl- 
edge of the subject be very thorough. Thus, he is told that ammonium 
chloride is a remedy in bronchitis, but the exact stage at which it is to 
be employed is often not stated, or he knows that digitalis does good 
in cases of cardiac disease, but fails to recognize the fact that it is 
only when compensation is lacking that the drug is needed. For this 
reason Part IV., on Applied Therapeutics, was written, not with the 
object of providing a rigid system for treating disease, but rather for 
the purpose of bringing together the best remedies, and of showing 
how and why they are given. 

The appearance of the new United States Pharmacopoeia in the sum- 
mer of 1905 has necessitated a large number of alterations in the text of 
this volume. Many preparations heretofore official have been excluded 
and new ones introduced. A large number of tinctures have been 
changed in their strength, and therefore in their doses. 

In many instances the names of drugs used by physicians for years 
have been greatly changed, as, for example, the substitution of acet- 
phenetidinum for phenacetin, or hexamethylenamine for urotropin. In 
cases such as these the author has intentionally allowed the older 
name to head the article on the subject at issue and given the new 

(v) 



Vi PREFACE TO ELEVENTH EDITION. 

name under it so that the reader may not be subjected to the annoy- 
ance of a cross-reference and may gradually become accustomed to 
the new nomenclature. It will be noticed that fluid extracts are now 
classified under the compound Latin term "Fluidextractum." 

Throughout this book, in every part where drugs or diseases are 
considered, the writer has arranged the titles in alphabetical order, 
according to the name commonly employed. This has been done 
because it is desired to afford the reader a ready reference book to 
which he may turn at short notice for desired information, for at 
present the state of pharmacology is so unsettled that a true classifi- 
cation is impossible. Thus, morphine may be classed by one writer 
as a nervous sedative, by another as a sleep-producer, by a third as a 
bitter substance, and by a fourth as a respiratory depressant. Bromide 
of potassium may, with equal propriety, be called a spinal sedative or 
a cerebral sedative, or caffeine be classed as a cerebral stimulant, a 
circulatory stimulant, or a diuretic. 

In order to make the book more complete, the preparations of the 
British Pharmacopoeia have been introduced; and with the same 
object in view, a dose list of drugs, both official and unofficial, has 
been appended for ready reference. The subject of medical electricity 
has heretofore commonly found a place in most text-books on thera- 
peutics, but has been advisedly omitted in this instance, since electrical 
therapeutics has outgrown any work save one devoted to that subject 
alone. 

For many of the articles on treatment the author wishes to thank 
friends who have earned prominence in connection with their specialties. 
Thus, Dr. G. E. de Schweinitz has contributed the articles on the treat- 
ment of diseases of the eye ; Dr. Edward Martin those on the treatment 
of venereal diseases and on antisepsis; Dr. Barton C. Hirst those on 
the treatment of diseases of the puerperal state. All of these articles 
enhance the value of the book to so great an extent that the author 
feels sure they will be sought out and read with interest. 

In addition to the general index, a copious and explanatory index 
of diseases and remedies has been appended, which will prove sug- 
gestive and valuable to practitioners. 

H. AH. 

N. W. COR. SPRUCE AND 18TH STS., PHILADELPHIA, 1905. 



CONTENTS. 



PART I. 

PAGE 

General Therapeutical Considerations .,.„.. 17 



PART II. 
Drugs . . 53 

PART III. 

Remedial Measures other than Drugs . . . . . .461 

Feeding the Sick , .' . 542 

PART IV. 

Treatment of Diseases 555 

Table of Doses of Medicines ......... 821 

Index of Drugs and Remedial Measures 837 

Index of Diseases and Remedies 863 



1 vii ) 



COMPARATIVE TABLE SHOWING THE STRENGTH OF THE MORE 
IMPORTANT PHARMACOP03IAL PREPARATIONS IN THE PRE- 
CEDING AND IN THE PRESENT PHARMACOPEIA. 



Title. 



Acidum sulphuricum aro- ) 
maticum . . . . $ 

Alcohol 

dilutum .... 
Caffeina citrata effervescens 
Calx chlorinata . 
Emplastrum belladonnae . 



Extraetum belladonnae 
colchici cormi 
hyoscyami 

nucis vomicae 



opu . ... 
physostigmatis 

stramonii 

Fluidextractum aconiti 
belladonnae radicis 

cinchonae 



colchici seminis . 
conii .... 
guaranae . . 
Hydrastis 
hyoscyami 

ipecacuanhas . 
nucis vomicae 

pilocarpi 
stramonii 

Liquor ferri chloridi . 

ammonii acetatis . 

tersulphatis . 
Lithii citras effervescens . 
Mangani dioxidum praecip- ) 
itatum . . . . j 
Oleatum hydrargyri . 

Opii pulvis .... 
Opium deodoratum . 
Pancreatinum 

Potassii citras effervescens 
Spiritus frumenti 
Suppositoria glycerini 

Syrupus ferri iodidi . 
Tinctura aconiti . . . -j 

aurantii dulcis 

belladonnae foliorum < 



Chief constituent. 



H 2 S0 4) by weight. 

Absolute alcohol, by weight. 
Absolute alcohol, by weight. 
Citrated caffeine, by weight. 
Available chlorine, " 
Mydriatic alkaloids, " 



Mydriatic alkaloids, ' ' 
Colchicine, by weight. 
Mydriatic alkaloids, by 

weight. 
Strychnine, by weight. 

Morphine (cryst.), by weight 
Ether-soluble alkaloids, by 

weight. 
Mydriatic alkaloids, by 

weight. 
Aconitine, by weight. 
Mydriatic alkaloids, by 

weight. 
Anhydrous ether-soluble 

alkaloids, by weight. 
Ether-soluble alkaloids, by 

weight. 
Colchicine, by weight. 
Coniine, by weight. 
Alkaloids, by weight 
Hydrastine, by weight. 
Mydriatic alkaloids, by 

weight. 
Alkaloids, by weight. 
Strychnine, by weight. 

Alkaloids, by weight. 
Mydriatic alkaloids, by 

weight. 
Anhydrous FeCl 3 , by weight. 
Tincture of ferric chloride. 
Fe 2 (S0 4 ) 3 , by weight. 
Lithium citrate, by weight. 

Manganese dioxide. 

Yellow mercuric oxide, by 

weight. 
Morphine (cryst.), by weight 
Morphine (cryst.), by weight 



Potassium citrate, by weight 
Absolute alcohol by weight 
Glycerin (half their former 

size). 
Ferrous iodide, by weight. 
Aconitine, by weight. 
Aconite. 

Sweet orange peel. 
Mydriatic alkaloids, by wt. 
Belladonna leaves. 



Pharm. 8th Revision. 



About 18.5 per ct. 


About 20.0 per cent. 


About 91.0 per ct. 


" 92.3 


About41.0per ct. 


" 41.5 • " 


2.0 gm.in 100 gm. 


4.0 gm. in 100 gm. 


At least 35.0 per ct. 


At least 30 per cent. 


Standard not fixed 


Not 1 ess than 0. 38 per 




cent, nor more 




than 42 per ct. 


" *' 


1.4 per cent. 


" " 


1.4 


" " 


0.3 


15.0 per cent, total 


5.0 


alkaloids 




18.0 per cent. 


20.0 


Standard not fixed 


2.0 


" 


1.4 


« 


0.4 gm. in 100 c.c. 


" " 


0.5 " 100 " 



1.5 gm. total alka- 
loids in 100 c.c. 
Standard not fixed 

37.8 per cent. 
2 c.c. in 100 c.c. 
28.7 per cent. 
About 17.0 per ct. 

At least 66 per ct. 

20.0 per cent. 

13 to 15 per cent. 
13 to 15 per cent. 
Standard not fixed 

About 48.0 per ct. 
44 to 50 per cent. 
6 gm. each 

About 10 per ct. 
Standard not fixed 
1 gm.in 2. 85 c.c. 
Igm.in5.0cc. 
Standard not fixed 
1 gm. in 6.67 c.c. 



4.0 

0.5 

0.5 

0.45 

3.5 

2.0 

0.075 

1.75 
1.0 

0.4 
0.35 



100 

100 

100 
100 
100 
100 
100 

100 
100 

100 
100 



29.0 per cent. 
4.0 C.C. in 100 c.c. 
36.0 per cent. 
About 5.0 per cent. 

At least 80 per cent. 

25.0 per cent. 

12 to 12.5 per cent. 
12 to 12.5 

At least 1 part digests 
25 parts of starch. 
About 20.0 per cent. 
37 to 47.5 
3 gm. each. 

About 5 per cent. 
0.045 gm. in 100 c.c. 
1 " 10 " 

1 2 " 

0.035 " 100 " 
1 " 10 " 



( viii ) 



STRENGTH OF PHARMACOPCEIAL PREPARATIONS. 



IX 



Title. 


Chief constituent. 


Pharm., 1890. 


Pharm. 8th Revision. 


Tinctura benzoini composita 


Benzoin. 


1 gm. in 8.33 c.c. 


1 gm. in 10 c.c. 


calumbse 


Calumba. 


1 " 10.0 " 


1 " 5 " 


cannabis indicae . 


Indian cannabis. 


1 " 6.67 " 


1 " 10 " 


cantbaridis . . 


Cantharides. 


1 " 20.0 " 


1 " 10 " 


capsici .... 


Capsicum. 


1 " 20.0 " 


1 " 10 " 


cardamom i . 


Cardamom. 


1 " 10.0 " 


1 " 5 " 


cinnamomi . 


Saigon cinnamon. 


1 " 10.0 " 


1 5 " 


colchici seminis . . -J 


Colcbicum seed. 


1 " 6.67 " 


1 '* 10 " 


Colchicine, by weight. 


Standard not fixed 


05 " 100 " 


digitalis . 


Digitalis. 


1 gm.in 6.67 c.c. 


1. " 10 " 


ferri chloridi . 


Anhydrous FeCl 3 ,'by weight. 


13.6 per cent, by 


13.28 per cent, by 






weight. 


weight. 


gambir composita . 


Gambir. 


1 gm. in 10.0 c.c. 


1 gm.in 20 c.c. 


gelsemii .... 


Gelsemium. 


1 " 6.67 " 


1 " 10 " 


bydrastis 


Hydrastine, by weight. 


Standard not fixed 


0.4 " 100 " 


byoscyami . . . \ 


Mydriatic alkaloids, by wt. 
Hyoscyamus. 


1 gm. in 6.67 c.c. 


0.007 " 100 " 
1 " 10 " 


kino .... 


Kino. 


1 " 10.0 " 


1 " 20 " 


lobelia .... 


Lobelia. 


1 " 5.0 " 


1 " 10 " 


nucis vomicae 


Strychnine, by weight. 


0.3 gm. total alka- 


0.1 gm. strychnine 






loids in 100 c.c. 


in 100 c.c. 


opii 


Morphine (cryst.) by weight. 


1.3 to 1.5gm. in 


1.2 to 1.25 gm. in 






100 c.c. 


100 c.c. 


opii deodorati 


Morphine (cryst.) by weight. 


1.3tol.5gm. in 


1.2 to 1.25 gm. in 






100 c.c. 


100 c.c 


physostigmatis . . -J 


Physostigma. 

Ether-soluble alkaloids, by 
weight. 


1 gm.in 6.67 c.c. 
Standard not fixed 


1 gm. in 10 c.c. 
0.014 " 100 " 


quassiae .... 


Quassia. 


1 gm. in 10.0 c.c. 


1 5 " 


rbei 


Rbubarb. 


1 " 10.0 " 


1 5 " 


sanguinarise . 


Sanguinaria, 


1 " 6.67 " 


1 " 10 " 


scillse ; 


Squill. 


1 " 6.67 " 


1 " 10 " 


serpentarise . 


Serpentaria. 


1 " 10.0 " 


1 5 " 


stramonii . . . -j 


Stramonium. 


1 " 6.67 " 


1 " 10 " 


Mydriatic alkaloids, by wt. 


Standard not fixed 


0.03 " 100 " 


stropbantbi . . 


Strop hanthus. 


1 gm. in 20. c.c. 


1 " 10 " 


tolutana .... 


Balsam of Tolu. 


1 " 10.0 " 


1 5 " 


veratri .... 


Veratrum. 


1 " 2.5 " 


1 " 10 " 


Trochisci cubebse 


Oleoresinof cubeb,by weight 


0.25 gm. in each 


0.125 " each 


Unguentum cbrysarobini . 


Chrysa robin, by weight. 


About 5.0 per ct. 


About 6 per cent. 


pbenolis. 


Phenol, by weight. 


" 5.0 " 


" 3 


sulpburus 


Washed sulphur, by weight. 


" 30.0 " 


" 15 


Vinum album 


Absolute alcohol, by weight. 


10.0tol4.0 " 


7 to 12 


colchici seminis . 


Fluidextract of colchicum 


1 gm. colchicum 


1 c.c. fluidextract 




seed. 


seed in 6.67 c.c. 


of colchicum seed 
inlOc.c. 


ergotse .... 


Fluidextract of ergot. j 1 gm. ergot in 


1 c.c. fluidextract 




6.67 c.C. 


ergot in 10 c.c. 


rubrum .... 


Absolute alcohol, by weight. 10.0 to 14.0 per ct. 


7 to 12 per cent. 



PAET I. 

GENERAL THERAPEUTICAL CONSIDERATIONS 



Before entering into a study of the action of drugs upon the living 
body, it is necessary that the student should possess a clear idea of 
what the word " therapeutics " means, that he should comprehend 
fully the reason why resort is had to drugs, and, more important than 
all, that he should grasp the limitations which govern the adminis- 
tration of remedies. 

Two unfounded ideas have been put forward by certain persons 
— one being, that medical therapeutics is useless; and the other, 
that this branch of medical knowledge is not advancing with so great 
a stride as are pathology and surgery. The individuals who deride 
the use of drugs in disease belong to one of two classes: either they 
have never tried them or have used them wrongly. 

The statement that therapeutics is to-day less advanced than are 
pathology and surgery is readily answered by a denial; for the thera- 
peutist is able to treat successfully many diseases of which the pathol- 
ogist knows nothing, and is obliged to rest his treatment on empiri- 
cism simply because he cannot tell how his drugs act if the pathologist 
cannot tell him in what the disease consists. Rheumatism and syphilis 
are good examples of this very point. 

In regard to surgery, every one must recognize the extraordinary 
advances made in this branch of medical science, yet comparatively 
few realize that it is solely by the proper use of drugs that all its tri- 
umphs are possible. The definition of the word "therapeutics" in 
Billings's Dictionary is: "That branch of medical science which treats 
of the application of remedies to the cure or alleviation of disease"; and 
practically the term is almost universally used to signify the employ- 
ment of drugs for such purposes. The credit for the introduction of 
new instruments and operations may be accorded to surgery, but the 
discovery of new drugs must be accorded to therapeutics. We find, 
then, that ether and chloroform began to revolutionize surgery more 
than sixty years ago, and that corrosive sublimate and other drugs 
have revolutionized it once more within the lifetime of every one who 
reads this book. Cocaine has changed the entire aspect of eye surgery 
and other minor operations, and has immediately averted an enormous 

2 (17) 



18 GENERAL THERAPEUTICAL CONSIDERATIONS. 

amount of pain and suffering which the surgeon could not mitigate, 
much less remove, in the absence of its influence. To the accusation of 
backwardness the therapeutist can well reply by asking the champion 
of any other branch of medical science to put forward one discovery 
which equals antipyrine or acetanilid in power to relieve pain; and 
last, but by no means least, he can point to those triumphs of modern 
therapeutics — the use of suprarenal gland as a vasoconstrictor, of 
thyroid gland for myxcedema, and of antitoxin for diphtheria. 

The man who does not believe in the proper use of remedies for 
the cure of disease lacks the very keystone of the arch upon which all 
medical investigation rests, for the ultimate aim and object of all 
medical thought and effort are the cure or alleviation of disease. Like 
every other thing requiring a thorough knowledge of its component 
parts, methods of treatment are often much abused by the careless and 
ignorant, but are a power for good in the hand of the properly educated 
physician. Further than this, therapeutics is the only universally used 
part of medicine, for each and every branch must resort to it, and 
the most expert operator who fails to treat his cases medicinally with 
equal skill will have worse results than he who, though bungling in 
his surgery, yet uses drugs intelligently after his operation is finished. 

Homoeopathy depends upon more than one reason for its existence. 
If infinitesimal doses are given, the patient is satisfied that he is receiv- 
ing medicine, and Nature often produces her most rapid cures when 
left alone. Again, the entire basis of homoeopathic therapeutics rests 
not upon the study of the causes of diseases, but upon the symptoms 
which constantly present themselves. As a result of this, many minor 
symptoms are relieved and the patient's confidence is won, although 
nothing is done to control the pathological process itself. No detail 
of diagnosis or treatment should be too small to attract the attention 
of the regular physician. 

The first duty of the physician when called to a case of illness is to 
reach a diagnosis as to the cause of the ailment, and not until he has 
formed a definite idea as to the condition which confronts him should 
he prescribe any medicinal agent. In certain cases where the symp- 
toms are severe or indicative of immediate danger it may be necessary 
to give relief by the use of temporary remedies, not only to save life, 
but also to remove symptoms which, because of their severity, mask the 
condition so that a diagnosis is impossible. Thus a patient may be 
found in collapse or in a state of syncope. The cause of this state 
may be obscure, but the pulse, heart-sounds, and respiratory action 
may indicate the need of immediate stimulation. In another instance 
agonizing pain, as that due to a crisis in locomotor ataxia, or renal or 
hepatic colic, may require a hypodermic injection of morphine as 
soon as the physician assures himself that the pain complained of is 
genuine. In other instances the case may be so obscure that several 
days of careful study may be necessary to reach a correct diagnosis, 
and during this time palliative remedies may be required. 



GENERAL THERAPEUTICAL CONSIDERATIONS. 19 

Before ordering a drug or method of treatment the physician should 
have a clear conception of what he is trying to accomplish. No 
remedy should be given unless there is a distinct indication for its use. 
The old-fashioned "shotgun" prescription, containing many ingredi- 
ents, one or more of which might hit the mark, should be supplanted 
by the small-calibre rifle-ball sent with directness at the condition to 
be relieved. Having decided upon the remedy indicated, the physi- 
cian must next determine the dose required. This latter decision is 
almost as important as the first, for very often an error in dosage will 
cause failure of the remedy. A large part of the therapeutic skill of 
the physician consists in fitting the dose to the needs of his patient. 

In the treatment of all forms of disease the physician must never 
forget the following influential factors in the case, which are often of 
greater importance than the measures devoted to the treatment of the 
disease itself: 

1. The maintenance of vital resistance by proper feeding. 

2. The elimination of effete materials by the kidneys, bowels, 
and skin. 

3. The relief of annoying symptoms which sap the patient's vitality 
and often obscure the true state of the system. 

4. That sufficient physical and mental rest and sleep are obtained 
if. possible. 

1. That the proper use of food in both acute and chronic illness is of 
great importance is not only manifest, but it has been proved by 
scientific investigation that lack of food often prevents the system 
from successfully combating the entrance and growth of infecting 
micro-organisms. The patient who has a greatly lowered vital resist- 
ance not only suffers from the effects of the particular disease by which 
he has been attacked, but not rarely dies from the growth of other 
micro-organisms which find him a fair mark for their attacks, thereby 
producing what Flexner has well called "terminal infections," and 
causing Osier to say that "a man rarely dies of the disease from which 
he is suffering," meaning by this that though he may be ill of a specific 
infection, other germs really produce the fatal issue. Care in feeding 
is therefore never to be ignored, and the various ways of feeding and 
preparing foods must be carefully studied. (See Part III.) 

2. It would seem hardly necessary to insist on the importance of 
maintaining the active elimination of impurities from the body were it 
not that so little attention is paid by some physicians to these functions. 
In all infectious diseases the kidneys are required not only to eliminate 
the ordinary waste products of the body, which usually escape in this 
way, but in addition the increased waste produced by the fever and the 
poisons produced directly and indirectly by the growth of the invading 
micro-organisms. It is essential therefore that the patient shall pass 
urine in sufficient amount to carry off these substances, and this result 
often may be obtained by giving plenty of water to drink and increas- 
ing diuresis by the use of sweet spirit of nitre and citrate or acetate 



20 GENERAL THERAPEUTICAL CONSIDERATIONS. 

of potassium. Nor is it sufficient to determine that the quantity of 
urine is normal. Estimations of the urea should be made in all serious 
cases, to ascertain whether the eliminating function of the kidney is 
active, for sometimes the flow of urine is sufficient, but the quantity of 
urinary solids is far below what it should be. Not rarely in disease, 
and even in apparent health, the patient states that his bowels have 
moved daily, and the physician is content with this report without 
making inquiries as to the quantity of the feces or whether the 
quantity is adequate in regard to the amount of food ingested. Even 
when the bowels are moved daily we may find after some days that 
there has been a partial retention of fecal matter, so that the colon 
becomes filled with feces. Sometimes moderate diarrhoea is an effort 
of nature to eliminate poisons, and is to be regarded as an aid to the 
patient, and not to be arrested by constipating remedies. It is also to 
be recalled that one of the functions of the liver is the elimination and 
destruction of toxic materials, and therefore the use of a cholagogue 
not only unloads the bowels, but also aids the liver in one of its most 
important duties. As the skin is an important eliminating organ, it 
must be kept clean by frequent washing, and if inactive it must be 
stimulated to increased activity by rubbing, and in some cases by hot 
packs or Turkish baths. (See Heat.) 

3. It is of importance, as already stated, that symptoms which 
accompany the progress of various forms of diseases should be modified 
or removed if they become sufficiently active to produce much discom- 
fort or disturb the patient's rest. Headache, backache, itching, wind 
colic, etc., can often be entirely removed by simple means, and some- 
times without the internal use of drugs. It is, on the one hand, impor- 
tant to avoid unnecessary discomfort; and, on the other, care must be 
taken that in the use of remedies to relieve annoying symptoms we 
do not mask important diagnostic factors in the case or influence 
unfavorably the course of the malady. Thus in appendicitis it is wise, 
as a rule, not to give morphine to relieve the pain, as it will quiet the 
patient so as to lead him and his attendants to regard the condition as 
actually healed, when in reality the pathological process is rapidly 
progressing. Only when the pain is agonizing ought sufficient of the 
drug be given to allay the excess of pain, and never enough to mask 
the real condition. It is of vital importance that the physician be not 
content with the relief of symptoms alone, but that he shall regard 
them as of little importance, while he searches for and, having found, 
tries to remedy the diseased state itself. Thus it would be folly to 
treat the headache of unemia and fail to treat the cause producing it. 

Not infrequently care is not taken to discover whether the patient 
has sufficient sleep or rest. It is perfectly true that if a sick man lies 
awake an hour he is apt to believe he has been awake all night; but, 
on the other hand, in severe illnesses prolonged actual wakefulness 
is a very exhausting feature of the attack. Every one of experience 
has seen cases rally when apparently in a most serious state, and con- 



MODES OF ADMINISTERING DRUGS. 21 

valesce, when a good sleep has been given them by the aid of judiciously 
used drugs. If the patient is getting about the normal amount of sleep 
in the twenty-four hours, hypnotics should be as much avoided as if 
they were poisons. 

MODES OF ACTION OF DRUGS. 

Drugs act in two ways, which are sometimes called near and remote, 
direct and indirect. The near, or direct, action of a drug is that influ- 
ence which is felt by the exercise of its effect directly upon the tissues 
with which it comes in contact; the indirect, or remote, influence is that 
result which comes as a sequence of its primary effect. As an illus- 
tration of this we may take the local use of cantharides. The local, 
near, or direct effect of this is a blister; the remote or indirect effect 
is the absorption of exudates or the influencing of inflammatory 
processes. If pilocarpine is used, its direct effect is the sweating 
which ensues, while its indirect effect is the relief of dropsy through 
the removal of exudate by the increased action of the skin, salivary 
glands, and the kidneys. 



MODES OF ADMINISTERING DRUGS. 

Drugs may be administered for the purpose of affecting the general 
system in many ways, but practically we employ only eight methods, 
as follows: 

1. By the mouth or stomach; 

2. By hypodermic injection; 

3. By inhalation; 

4. By the rectum; 

5. By inunction; 

6. By fumigation; 

7. By the endermic method; 

8. By cataphoresis. 

By far the most usual manner of administering drugs is by way of 
the mouth, which is the natural means of entrance into the body for 
foreign substances. Whenever medicines are used in this way the 
physician should clearly bear in mind what the medicine is to do after 
it is swallowed. Thus, if the drug is intended to act directly upon 
the stomach, it should not be given after meals, but some time before, 
since the food and gastric juice may afterward so cover the gastric 
mucous membrane that the medicament cannot act upon it. Thus, 
in a case of chronic gastric catarrh or gastric ulcer, the nitrate of silver 
which is used should always be given half an hour or an hour before 
meals. On the other hand, if an ulcer or other trouble exist in the 
small intestine, the pill should be given some time after meals, and 
if a heavy meal is taken, three or four hours after, since under these 



22 



GENERAL THERAPEUTICAL CONSIDERATIONS. 



circumstances the medicine is swept out into the intestine almost at 
once, without remaining any time in the stomach, where it may be 
chemically altered. Very often it is necessary to give a medicine soon 
after food is taken in order that it may not act in too powerful or con- 
centrated a manner upon the viscus which receives it or upon the 
general system by reason of its rapid absorption in concentrated 
form. 

The general rule, however, may be laid down that all medicines 
are to be taken after rather than before meals, unless a local gastric 
effect or very rapid absorption is desired. 

Next to the use of drugs by the mouth, by far the most popular 
method is their administration by means of the hypodermic needle and 



Fig. 1. 




Method of giving a hypodermic injection. The skin having been sterilized, the needle is 
then pushed into the subcutaneous tissues, as shown in the illustration. If the injection is 
given into the forearm, the skin of the part into which the injection is to be given is to be 
raised by grasping it between the thumb and fingers of the left hand to aid in holding the 
forearm steady. 



syringe. The logic of this method rests upon the absorption of all 
soluble substances from the subcutaneous tissues with great rapidity. 
Any substance soluble enough or suspendable enough to pass through 
a hypodermic needle without forming an obstruction may be employed, 
provided it is not too irritating and that it is " clean." 

The proper places to give such injections are the forearm on the 
extensor surface, 1 the calf of the leg, the buttock, or the broad of the 



1 Hypodermic injections into the anterior aspect of the forearm often cause much pain in the 
hand by irritating temporarily the branches of the radial or ulnar nerves. 



MODES OF ADMINISTERING DRUGS. 23 

back — in other words, any spot where the tissues are not dense and 
unyielding. The skin of the part is to be grasped or pinched up with 
the thumb and forefinger of the left hand and the needle sent well into 
this raised fold, preferably above the finger and thumb, so that the 
pressure of the fingers may prevent pain and hold the part steady. 
The needle should always penetrate well into the loose connective 
tissue, so that the liquid injected may find lodgment in the relaxed 
and spongy subcutaneous tissues without separating the skin from its 
rather close adhesions to the tissues below or from the bloodvessels 
supplying it, for if separation occurs abscess and a slough may result. 

Meltzer and Auer have shown that the rapidity of the absorption of 
a drug when given by the hypodermic needle is greatly increased if it 
be injected into the belly of one of the larger muscles. This rapidity 
of action almost equals that of an intravenous injection. 

The dangers from hypodermic injections are chiefly two. First: 
The needle may enter a vein, and the entire dose be carried at once, 
en masse, to the vital centres. Second: The solution or needle used 
may not be sterile, and an abscess result. The first danger is to be 
avoided by injecting into parts not well supplied with veins, and the 
second by thoroughly washing both syringe and needle with sterile 
water the instant before they are used, pushing a fine wire through 
the needle, and in some cases by soaking the instrument in carbolized 
oil. The solution injected should be prepared by using freshly boiled 
water and adding thereto carbolic acid in such proportion that one- 
half drop is present in each injection if a solution is to be permanent. 
It is claimed by some that this use of carbolic acid seriously hinders 
absorption, and in cases of urgency it should not be used. Most 
physicians now make a solution for immediate use by adding a small 
tablet of the required drug to 20 minims of water at the moment it is 
needed. A third danger supposed to exist by some persons, but prob- 
ably more feared than need be, is the injection of air into a vein with 
the medicament. It is well to see that all air is expelled from the 
syringe before making the injection. Most hypodermic syringes hold 
from twenty to thirty minims. 

When drugs are given by the rectum, we employ them for three 
purposes: first, to influence the general system by their absorption; 
secondly, to act locally upon any disease which may be present in this 
particular locality or in the colon; and, finally, to dislodge substances 
or parasites which it is desired to bring away. The word "enema" 
is loosely used to denote all these injections, be their purpose what 
they may, and is synonymous with "rectal injection " or the more 
old-fashioned word "clyster." If nourishment is being given, the 
injection is called a "nutrient enema." Sometimes these injections 
are called "lavements." 

In this mode of administration it is very necessary that the physi- 
cian should use the medicaments in proper bulk; and it may be laid 



24 GENERAL THERAPEUTICAL CONSIDERATIONS. 

down as a rule that no more liquid should be injected than is neces- 
sary to convey the medicine or food, unless the injection is for the 
purpose of emptying the bowel of fecal matter or other materials, or 
it be desired to distend the bowel in order to overcome obstruction, or 
to influence the colon by drugs. 

The reason for this lies in the fact that any large bulk of liquid 
sent into the rectum so stimulates the walls by distention as to cause 
spasmodic contraction, with expulsion of all the rectal contents, which 
is just what is needed when fecal matter is to be removed, but the 
opposite of what is desired when retention of a remedy or food is 
necessary for absorption or local action. In rectal catarrh or ulcers 
two to four ounces of liquid are usually sufficient in an adult to accom- 
plish any medicinal influence locally or by absorption, while as a laxa- 
tive enema one to two pints may be employed. 

In the use of injections the rectum frequently becomes irritable, 
and resists all efforts to force the entrance of liquids or solids. This is 
to be avoided by giving the injection so gently that the bowel fails to 
recognize, as it were, the entrance of the liquid, and by introducing a 
few drops of oil and laudanum in each injection. 

A large amount of distress often follows the gradual accumulation 
of fecal masses in the colon which are not passed with the daily move- 
ment of the lower bowel. These can readily be removed by large 
injections of warm water or by the use of medicated liquids. 

A very important use of injections by the rectum is in the treat- 
ment of the various causes of intestinal obstruction. Here the greatest 
caution should be exercised that the injection be made with all possible 
gentleness, and be introduced slowly, the liquid being allowed to 
dribble into the bowel rather than to force its way. It is dangerous 
to use a greater pressure than is given by a fountain syringe at the 
height of two or three feet, as rupture of the peritoneal coat of the 
bowel may occur. Where a large quantity of water is used, it should 
be warmed to 100° F. or a little more, and it is well to add salt to it, 
so that it will represent the normal saline strength of blood-serum, 
namely, 0.7 per cent. (For use of injections in special diseases see 
Part IV., and for Enteroclysis, Part III.) 

Suppositories are another means by which medicines are introduced 
into the bowel, either for local effect or to act, after absorption of their 
contents, upon the general system. 

When drugs are given by inhalation they are generally employed 
with the object of affecting the respiratory tract alone ; notable excep- 
tions are ether, chloroform, nitrous oxide gas, and other volatile sub- 
stances. Aside from anaesthetics, are such remedial measures as the 
inhaling of steam laden with the drugs employed, the respiring of air 
charged with the fumes of the medicament, or the inhalation of gases, 
and last, and most commonly resorted to of all, the use of the vapor- 
izer, which, if properly made and employed, so minutely divides the 
liquid containing the medicament that the inspired air carries it to the 



MODES OF ADMINISTERING DRUGS. 25 

farthest bronchiole and pulmonary vesicle. (See Part III.) Atomized 
sprays have also been found to possess great penetrating power in the 
treatment of inflammations under the skin or mucous membranes, 
as, for example, boils and carbuncles. 

As an example of the rules governing the administration of drugs in 
this manner we find that compound tincture of benzoin may be taken 
by inhaling the steam arising from hot water containing it, but cannot 
be used in a spray because it occludes the fine points of the atomizing 
tubes. In a similar manner the smoke of belladonna or tobacco-leaves 
may be inhaled to relieve asthma, or the fumes of chloride of ammo- 
nium for bronchitis in its later stages. Fumigation with mercury, 
the sublimed vapor being inhaled, is also useful in syphilis. Finally, 
we find that oxygen is sometimes very useful, the gas being readily 
inhaled, with good results in proper cases. 

The "spray" or atomizer is made in two forms — one form of appa- 
ratus being operated through the agency of compressed air, the other 
through the escape of steam from a small boiler. Very few of the 
compressed-air atomizers throw a spray sufficiently fine to reach the 
deeper parts of the lungs, particularly if the air is compressed by the 
hand; but all instrument-makers now sell vaporizers or nebulizers 
which so minutely divide the liquid medicament that it readily enters 
the deeper parts of the lungs. 

The inhalation of moist air is very useful in bronchitis, and greatly 
aids other remedial measures. Steam may be disengaged in a room 
by means of a kettle of boiling water or by placing pieces of unslaked 
lime in a pan of water. 

Inunctions consist in the rubbing into the skin of medicines generally 
of an oily or fatty nature, or which assume this character through 
embodiment with oil or fat. The three substances most commonly 
used in this way are cod-liver oil, mercurial ointment, and iodine oint- 
ment. They should always be applied on some part where the derm 
is thin and well supplied with subcutaneous lymphatics, as in the 
axillae, the groins, or the insides of the thighs. Other substances 
have been and may be used by inunction; but as this method is neces- 
sarily a disagreeable and dirty one, it is rarely resorted to unless the 
stomach is disordered or it is necessary to cause absorption of the drug 
by the system by every possible avenue of entrance. 

The endermic method consists in the use of a blister, by means of 
which the epiderm is raised, when a little morphine or other alkaloid 
may be slipped under it and so absorbed through the true skin. It 
is a painful method, almost never to be resorted to, having been 
supplanted by the hypodermic method of medication. 

Drugs are also sometimes caused to enter the body through the skin 
by placing them in plasters or poultices, or by the electrical process 
called cataphoresis. (Part III.) 



26 GENERAL THERAPEUTICAL CONSIDERATIONS. 

Remedies are administered in a number of forms, but chiefly as 
follows : 

Abstracts are dry powdered extracts mixed with sugar of milk 
until they are twice as strong as the crude drug. Abstracts are no 
longer official in the United States Pharmacopoeia. 

Aceta, or vinegars, are solutions of the active principles of drugs in 
vinegar or dilute acetic acid. There are two in the United States Phar- 
macopoeia (Acetum Opii and Acetum Scillce) and three in the British 
(Acetum Cantharidis, Acetum Ipecacuanha?, and Acetum Scillw). 

Alkaloids are organic bases, forming salts with acid radicals, gen- 
erally occurring in crystalline form and abstracted from crude drugs. 
They nearly always represent the active principle of the drug. 

Aqtle, or waters, are used as vehicles either for the dilution of strong 
medicines or for the purpose of carrying minute amounts of flavoring 
materials. 

Cataplasms are not official in the United States Pharmacopoeia. 
They are virtually poultices made of linseed-meal or of bread-crumbs. 

Cerates are ointments containing wax to render them harder than 
would ordinary fats. 

Chart.e, or papers, consist of bibulous paper soaked in a solution 
of the drug which they are intended to carry. 

Confections are sometimes called electuaries or conserves, and 
are soft pastes which contain the drug mixed with sugar or honey. 

Decoctions are solutions of drugs made by boiling and then strain- 
ing while hot. 

Elixirs are diluted tinctures rendered pleasant to the taste by the 
addition of aromatic substances and sugar. 

Emplastra, or plasters, are made up of adhesive substances placed 
upon a backing of cloth or leather and designed to adhere to the skin, 
being so applied for the purpose of holding a medicinal substance in 
contact with the body, of acting as a protective, or of aiding in the 
approximation of the edges of a wound. 

Emulsions are liquid preparations which consist of oily substances 
minutely subdivided and held in suspension usually by some gummy 
material mixed with water. 

Extracts consist of the soluble parts of plants reduced to a semi- 
solid or solid condition by evaporation; the soluble constituents being 
taken from the plant by water or alcohol. 

Fluid Extracts are made in the same way as solid extracts, except 
that they are not so completely evaporated. 

Glycerita, or glycerites, are solutions of various substances in 
glycerin — the glycerin being used as a vehicle. 

Infusions are made by pouring boiling water on the crude drug 
and allowing it to stand for a short time until the water cools, after 
which the liquid is strained. Sometimes cold water is employed. 

Liniments are made of oily substances often mixed with powerful 
drugs to increase their efficiency. 



DOSAGE. 27 

Liquors are usually watery solutions of non-volatile drugs. 

Mixtures are composed of two or more drugs or of a single drug 
partly dissolved and partly in suspension. 

Pills are small round masses which, as a general rule, should not 
weigh more than three grains, in order to avoid too great bulk. If 
the material is a heavy one, as much as five grains may be placed in 
each pill. Pills may be without covering or coated with sugar or 
gelatin to preserve them and prevent the patient from tasting their 
contents. Sugar-coated pills must always be fresh and the sugar- 
coating pure. Gelatin is the best coating for pills. Many pills are 
fraudulently coated with varnish and are insoluble. 

Spirits are alcoholic solutions of volatile substances. 

Suppositories are small masses made into a cone shape and having 
for their basis cacao butter. They are designed to carry into the 
rectum certain medicines for absorption into the system or for local 
action. 

Syrups are solutions of sugar or gummy substances in water. They 
are used as vehicles. 

Tablets. — Under this name manufacturing pharmacists and others 
prepare compressed pills or lozenges, generally of small size, the mass 
being made to adhere by means of its being subjected to great pressure 
by special machinery. Smaller tablets are used for carrying powerful 
drugs for hypodermic use. These, however, are often only lightly 
pressed, so as to render them easily soluble. 

Tinctures are solutions of the active principles of drugs in alcohol 
or in mixtures of alcohol and water. 

Triturates are made by adding 10 per cent, of the active medicine 
to 90 per cent, of milk-sugar, These are then carefully rubbed together 
until the two are intimately mixed. Triturates are valuable in the 
administration of medicines to adults or to children. These trit- 
urates are often made into tablets, forming what are known as 
"Tablet Triturates." 

Troches, or lozenges, are flat, hardened, medicated masses designed 
to be held in the mouth, so that they may be slowly dissolved, thereby 
affecting the local mucous membrane. 

Ointments, or unguents, consist of the mixture of some kind of 
fatty substance with the medicine which they are designed to carry. 

Wines are made in the same way as tinctures — strong white wine 
being used in the United States, and sherry or orange wine in Great 
Britain, in place of ordinary alcohol. 

DOSAGE. 

For several reasons there is no absolutely fixed rule which can 
be applied to dosage. In the first place, the individual may not be 
readily affected by drugs, or the disease-process present may so 
antagonize them as to render very large doses necessary. Further, 



28 GENERAL THERAPEUTICAL CONSIDERATIONS. 

the age and sex of a patient have much to do with the regulation of 
the proper amount of a drug to be employed. Finally, that curious 
but common condition of susceptibility to various remedies, that we 
call idiosyncrasy, creeps in as an important factor in the decision as 
to the dose which should be given in each case. By far the nearest 
approach which can be made to absolute accuracy in dosage is to use 
drugs according to the weight of the patient, but this method possesses 
the disadvantages that we cannot always weigh our patients, and that 
the presence of a large amount of fat or of dropsy will make an 
unknown quantity in the calculation as to the true weight of the active 
part of the individual. 

At present we are accustomed to be governed by a list of doses to 
be given to all adults within certain limitations, and which are varied 
sufficiently to permit of great differences in the effects obtained. It 
is in this very point that the success of many a physician chiefly rests; 
for the use of a dose by "rule of thumb" is as empirical and lacking 
in thought as is use of a remedy, not because we have a definite action 
for it to carry out, but because it did some one else good who was 
suffering from what appears to have been a similar attack. The dose 
must be varied to fit the case in the same manner that the cut of a 
coat must be varied to fit each individual. 

There are a number of approximate rules in regard to the doses 
which are to be given in treating the diseases of children, the best of 
which is Young's rule. This is as follows: 

Add 12 to the age and divide by the age. Thus, if a child is two 
years old, we have the following formula: 2+12=14^-2=7, or, one- 
seventh of the dose for an adult is the dose for a child of two years. 
This rule is not a law, however, for of narcotics children should receive 
less than this (one-half), and of purgatives or laxatives more than this 
(two or three times). 

When drugs are given hypodermically the dose should be generally 
one-half to one-quarter of that given by the mouth; and if any sus- 
picion of idiosyncrasy exist, the dose should be smaller still at first 
if powerful remedies are to be used. 

By the rectum the dose should be twice the amount given by the 
mouth, unless the drug be very powerful or capable of very rapid 
absorption. 

When ordering liquid medicines in small amounts the prescription 
should always call for minims rather than drops, for the size of a drop 
varies with the particular liquid with which we are dealing and the 
shape of the mouth of the vessel containing it. This is well shown in 
the following table, compiled by Kinsey, and originally published in 
the American Journal of Pharmacy : 



DOSAGE. 



29 



Acetum lobeliae , 

Acetum opii 

Acetum sanguinariae . . . 

Acid, acetic 

Acid, acetic, dilute . . . . , 

Acid, carbolic 

Acid, hydrobromic. ... 
Acid, hydrochloric. . . . 
Acid, hydrochloric, dil. . . 

Acid, nitric 

Acid, nitric, dilute . . . . , 
Acid, nitrohydroehloric. . 
Acid, nitrohydrochloric. di 

lute 

Acid, phosphoric 

Acid, sulphuric 

Acid, sulphuric, dilute . . . 
Acid, sulphuric, aromatic. , 

Aqua ammoniae 

Aqua destillata 

Liquor potass, arsen 

Oleum anisi 

Oleum amygdalae amar. . 

Oleum cari 

Oleum chenopodii 

Oleum carophylli J 

Oleum cinnamomi 

Oleum crotonis 

Oleum cubebse 

Oleum gaultheriee 

Oleum hedeomse 

Oleum lavandulae 

Oleum monardae 

Oleum menthse pip 

Oleum menthae viridis . . . 

Oleum myristicee 

Oleum origani , 

Oleum pimentae 

Oleum rosmarini 

Oleum sassafras 



Dropped from 



& o 



51 
66 
102 

82 
94 
82 
57 
60 
70 
82 
63 
87 



54 
160 
57 
97 
45 
64 
58 
76 
102 
108 
94 
98 
77 
84 



95 
105 
82 
88 
95 
98 
91 
102 
92 
83 



74 

54 
43 
152 
'47 
94 
41 

'61 
73 

77 
84 
75 
75 
73 
62 
80 
93 
83 
78 
76 
73 
81 
83 
83 
86 
88 
77 



as 
3 s 



64 
65 
92 

101 
99 

110 
70 
96 
62 

124 
81 
92 

62 

62 

172 

60 

144 

54 

61 

77 

112 

75 

133 

129 

133 

112 

104 

120 

136 

130 

133 

125 

132 

132 

128 

133 

133 

133 

142 



Oleum tanaccti . . . 
Oleum terebinthinee . 
Spiritus ammon. ar. . 
Spiritus camphoree . 
Spiritus aether, comp. 
Spiritus aether, nitr. . 
Spiritus menthse pip. 
Syrupus scillae comp. 
Tinctura aconiti . . 
Tinctura asafcetidae . 
Tinctura belladonnae 
Tinctura benzoini co. 
Tinctura cannabis ind 
Tinctura cantharidis 
Tinctura capsici ... 
Tinctura colchici . . 
Tinctura digitalis . . 
Tinctura ferri chlor. 
Tinctura hyoscyami 
Tinctura ignatiae . . 
Tinctura iodi .... 
Tinctura kino .... 
Tinctura krameriae . 
Tinctura lavand. co. 
Tinctura lobeliae . . 
Tinctura myrrhae . . 
Tinctura nucis vomicae 
Tinctura opii .... 
Tinctura opii cam ph. 
Tinctura opii deodor. 
Tinctura rhei .... 
Tinctura sanguinariae 
Tinctura stramonii . 
Tinctura tolutani . . 
Tinctura veratri virid 
Vinum aloes ... 
Vinum colchici rad. . 
Vinum colchici sem. 
Vinum ergotae .... 
Vinum opii 



Dropped from 



110 

103 

108 

98 

120 

88 

98 

106 

120 

102 

94 

98 

124 

118 

116 

86 

114 

108 

114 

112 

112 

116 

117 

97 

110 

100 

112 

98 

94 

109 

98 

110 

100 

120 

108 

71 

92 

86 

148 



87 
102 
85 
81 
81 
120 
97 
88 



97 
100 



79 

95 

105 

92 



82 



a I 



ss 



136 
142 
139 
140 
140 
144 
143 
122 
164 
145 
128 
146 
98 
136 
143 
124 
145 
139 
147 
140 
144 
148 
150 
141 
138 
145 
148 
143 
135 
141 
144 
134 
120 
156 
152 
94 
95 
105 
122 
102 



Fig. 2. 



Fig. 3. 



Fig. 4. 






Graduated medicine glasses. 



Doses are also ordered in teaspoonful, dessertspoonful, and table- 
spoonful quantities. Sometimes they are given by the wineglassful, 
meaning by this term a sherry-glassful. Roughly estimated, a tea- 



30 GENERAL THERAPEUTICAL CONSIDERATIONS. 

spoonful equals a fluidrachm (4.0), a dessertspoonful two fluidrachms 
(8.0), and a tablespoonful half a fluidounce (15.5). As spoons and 
wineglasses vary considerably in capacity, it is always best to use a 
graduated medicine glass, such as is shown in Figs. 2, 3, and 4. 

WEIGHTS AND MEASURES. 

There are two systems of weights and measures employed in the 
United States at the present time. The one most commonly used 
is the old-fashioned system of Apothecary weights for solids, and the 
Wine, or Apothecary, measures for liquids. The newer and more 
accurate system is that known as the Metric, or Decimal system of 
weights and measures, which is now recognized and recommended by 
the Pharmacopoeias of the United States, Great Britain, Germany, 
and France. 

The divisions of Apothecary weights are the pound, the ounce, 
the drachm, the scruple, and the grain. The scruple, which equals 
20 grains, has dropped out of use, chiefly because the scruple mark 
when written somewhat resembles that of the drachm. We may say, 
therefore, that the Apothecary weights consist of a pound, equalling 
12 ounces, or 96 drachms, or 5760 grains; that the ounce represents 
8 drachms, or 480 grains; and that the drachm equals 60 grains. 
The abbreviation for the word grain is "gr."; for the drachm, 3; f° r 
the ounce, 5 \ an d the pound, lb. 

In the Wine, or Apothecary, measures we have the gallon, the pint, 
the fluidounce, the fluidrachm, and the minim. In each gallon there 
are 8 pints, 128 fluidounces, 1024 fluidrachms, and 61,440 minims. 
In each pint there are 16 fluidounces, 128 fluidrachms, and 7680 minims. 
In each ounce there are 8 fluidrachms and 480 minims. In each drachm 
there are 60 minims. The abbreviation of the Latin word " minimum " 
or " minim " is n\ ; of the fluidrachm, f 3 ; of the fluidounce, f g ; of a pint, 
or "octarius," O; and of the gallon, or "congius," Cong. 

The British Pharmacopoeia has adopted the Avoirdupois system 
of weights, and thereby has a system which differs somewhat from 
the Apothecary weights of the United States Pharmacopoeia. The 
Avoirdupois pound represents 16 ounces, or 7000 grains; the Avoir- 
dupois ounce, 437.5 grains. It will be seen, therefore, that the Apothe- 
cary pound contains 1240 grains less than the Avoirdupois pound, 
but that the Apothecary ounce contains 42J grains more than the 
Avoirdupois ounce. Fortunately, however, the grain, both of the 
Apothecary and Avoirdupois systems, is of identical value. So, too, 
the British Pharmacopoeia uses what is known as the Imperial system 
of measures in place of the Wine measures used in the United States. 
Thus, the Imperial gallon represents 8 pints, 160 fluidounces, 1280 
fluidrachms, and 76,800 minims; the Imperial pint, 20 fluidounces, 160 
fluidrachms, and 9600 minims; and the fluidounce, 8 drachms or 480 
minims. The fluidrachm equals 60 minims. It will be seen, there- 



WEIGHTS AND MEASURES. 31 

fore, that the Imperial measure differs from the Wine measure chiefly 
in having 20 fluidounces in each pint, instead of 16. So, too, the 
weight of the Imperial fluidounce contains the same number of grains 
as the Avoirdupois ounce, which is 18.2 grains less than the weight 
of the United States fluidounce, which is 455.7. These differences 
between the weights and measures used in the United States and 
Great Britain are, therefore, of little importance when we are employ- 
ing grains or minims, but they become of great importance when we 
employ ounces, and of still greater importance when we employ pounds 
or pints. In the average prescription, however, which rarely exceeds 
three or four ounces, the difference in quantities in the United States 
and Great Britain are not of very great importance. 

The advantages of the metric system over these irregular systems 
of weights and measures are the same as those of the decimal system 
of currency over the English system of pounds, shillings, and pence. 
The unit of all calculations is the metre, which in the metric system 
is the unit of length. From this is derived the unit of capacity, the 
litre, which is the cube of one-tenth of a metre; and from the litre is 
derived the unit of weight, the gramme, which is the one-thousandth 
part of the weight of a litre of distilled water at its maximum density. 
As a matter of fact, the metric system is no more difficult to master 
than is the system of dollars and cents. The great difficulty is that 
the majority of physicians having learned the doses of various prepara- 
tions in the Apothecary weight find it difficult to begin using the metric 
system, and do not take the trouble to convert the Apothecary doses 
into this system. 

In the metric system we have the gramme, which may be said to be 
the equivalent of the dollar; the decigramme, or one-tenth of a gramme, 
which represents the dime; the centigramme, or one-hundredth of a 
gramme, which represents the cent; the milligramme, or the one- 
thousandth of a gramme, which represents the mill. Above the 
gramme in quantity we use what is known as the decagramme, which 
corresponds to the gold eagle, or ten dollars; the hectogramme, which 
corresponds to one hundred dollars ; and the kilogramme, which corre- 
sponds to one thousand dollars. 

When we come to the use of the metric system for fluids, we use as 
the unit the cubic centimetre (c.c.) in place of the gramme; a cubic 
centimetre representing 1 fluid gramme. 

When it is wished to convert grains into their metric equivalent, 
it must be remembered that 0.065, or 65 milligrammes, is the equiva- 
lent of 1 grain. Therefore, the following examples may be used: 



3 grains are 
60 grains " 
i grain is 


equal 

a 


to 3 X 0.065 = 0.195 
" 60 X 0.065 = 3.9 
" \ of 0.065 = 0.0162 


gramme. 

grammes. 1 

gramme. 


rb g rain is 


ti 


" T ^ of 0.065 = 0.00065 

Usually considered 4.0. 


gramme. 



32 GENERAL THERAPEUTICAL CONSIDERATIONS. 

To convert grammes into grains, instead of multiplying by 0.065, 



we divide, thus: 

Gramme 0.12 is equal to 0.12 
Grammes 3.9 are " " 3.9 
Gramme 0.06 is " " 0.06 
Gramme 0.0006 " " " 0.0006 



0.065= 1.8 grains. 
0.065 = 60 grains. 

0.065= 0.9 grain. 
0.065= 0.0092 grain. 



When we wish to convert apothecaries' drachms into grammes, we 
multiply the number of drachms by 3.9, or more commonly, though 
less accurately, by 4.0. Thus: 

10 drachms X 4.0 == 40 grammes, or, more accurately, 
10 drachms X 3.9 = 39 grammes. 

When grammes are to be converted into drachms, we divide the 
number of grammes by 3.9, or approximately 4.0. Thus: 

10 grammes -r- 3.9 = 2.56 drachms, or, less accurately, 
10 grammes -=- 4.0 == 2.5 drachms. 

When Apothecary ounces are converted, we multiply by 31.1; or, if 
grammes are to be converted into ounces, we divide by 31.1. Thus: 

2 ounces X by 31.1 = 62.2 grammes. 
40 grammes -r- by 31.1 = 1.25 ounces. 

As accurate translation of apothecaries' weights into the metric 
system leaves a fractional quantity in almost every instance, and as 
the translation of the metric system into apothecaries' weights does 
likewise, the author has for the sake of presenting even figures, and 
therefore rendering the interchange practicable, considered that the 
Apothecary ounce and the fluidounce are equal to 30 grammes or 30 
cubic centimetres, although a more accurate estimate of the ounce is 
31.1 and of the fluidounce is 29.57. 



WEIGHTS AND MEASURES. 



33 



TABLES OF RELATIVE WEIGHTS AND MEASURES IN THE 
METRIC AND APOTHECARIES' SYSTEMS. 

(See Oldberg's Manual of Weights and Measures.) 







Milligrammes 


in Grains. 






Milligramme 




Grain. 


Milligrammes. 


Grain. 


Milligrammes. 


Grain. 


0.1 


== 


~sm 


1 


= 


eV 


8 


= 


1 

8 


0.2 


= 


SWU 


1.2 


= 


l 


9 


= 


y 


0.3 


= 


l 

2^0" 


1.6 


= 


A 


10 


= 


i 

6 


0.4 


= 


1 

T50 


2 


= 


sV 


12 


= 


* 


0.5 


= 


T20" 


3 


= 


^ 


16 


= 


1 

4 


0.6 


= 


TOO 


4 


= 


tV 


20 


■ = 


* 


0.7 


= 


9 X 


5 


= 


A 


30 


= 


1 


0.8 


= 


& 


6 


= 


A 


60 


= 


1 


0.9 


= 


yV 


7 


= 


1 












C 


CENTIGRAMMES 


in Grain 


s. 






Centigrammes 


Grain. 


Centigrammes. 


Grains. 


Centigrammes 




(or Cent.) 




(or Cent.) 




(or Cent.) 


Grains 


1 


= 


I 


6 


= 


1 


18 


= 


3 


2 


= 


l 

if 


7 


=3 


1* 


25 


= 


4 


3 


= 


1 

2 


9 


= 


H 


50 


= 


8 


4 


= 


2 


10 


= 


if 


75 


= 


12 


5 


= 


f 


12 


= 


2 . 


100 


= 


16 








Grammes in 


Grains. 








Grammes. 




Grains. 


Grammes. 




Grains. 


Grammes. 




Grains. 


0.001 


= 


l 

SO 


11 


= 


176 


27 


= 


432 


0.010 


== 


* 


12 


= 


192 


28 


= 


448 


0.100 


= 


If 


13 


= 


208 


29 


= 


464 


0.250 


= 


4 


14 


= 


224 


30 


= 


480 


0.500 


= 


8 


15 


= 


240 


31 


= 


496 


0.750 


= 


12 


16 


== 


256 


32 


= 


512 


1 


= 


16 


17 


= 


272 


33 


= 


528 


1.50 


= 


24 


18 


= 


288 


34 


= 


544 


2 


= 


32 


19 


= 


304 


35 


= 


560 


3 


= 


48 


20 


= 


320 


36 


= 


576 


4 


= 


64 


21 


= 


336 


37 


== 


592 


5 


= 


80 


22 


= 


352 


38 


= 


608 


6 


= 


96 


23 


= 


368 


39 


= 


624 


7 


= 


112 


24 


== 


384 


40 


== 


640 


8 


= 


128 


25 


= 


400 


50 


= 


800 


9 


= 


144 


26 


= 


416 


100 


= 


1600 


10 


= 


160 















34 



GENERAL THERAPEUTICAL CONSIDERATIONS. 



Cubic Centimetres (or Fluidgrammes) in U. S. Apothecaries' 
Fluidrachms. 



Cubic 

Centimetres. 

1 

2 
3 
4 
5 
6 
7 



U.S. 

Fluidrachms. 

1 

4 

l 

2 



If 



= 2 



Cubic 
Centimetres. 

9 ' 
10 
11 
12 
13 
14 
15 



U.S. 
Fluidrachms. 

= 2| 

= 2i 

= 2f 

= 3 

= H 

= 3* 
= 3f 



Cubic 

Centimdtres. 

16 

20 

24 
28 
32 
48 
64 



U.S. 
Fluidrachms. 

4 

5 

6 

7 

8 

12 
16 



ABSORPTION OF DRUGS. 

Knowledge of the rapidity with which certain drugs are absorbed 
from the various surfaces with which they come in contact is of impor- 
tance in order that we may know when to repeat the dose if the first 
amount does not produce the desired effect. The rapidity of absorption 
depends upon a number of factors. If the circulation is active, absorp- 
tion is rapid; but if it be depressed, absorption is slow. Thus, in a 
person apparently drowned, absorption may not occur at all until the 
vital functions are restored, and repeated doses given to the patient 
while unconscious, acting together, in the end poison him. This is 
often the case in delirium tremens when hypodermic injections of 
morphine are given or when the drug is administered by the mouth. 
In dropsy absorption is peculiarly slow, and a medicine may remain 
in the tissues for days, only to be absorbed with the exudate after 
severe purgation or profuse diuresis, or tapping. In general dropsies 
hypodermic medication is nearly always worse than useless. 

When the stomach or bowel is empty absorption from either is rapid, 
but when they are full it is very slow. In this fact we find the reason 
for the popular idea that a glass of whiskey when a man is hungry 
makes him drunk, whereas twice the quantity after a meal does not 
do so. 

Drugs in the stomach or bowel have no influence upon the general 
system unless they are irritants. They only act when taken into the 
blood or lymphatics. 

Recent studies show that alcoholic solutions of drugs are more rapidly 
absorbed than are watery solutions or those made with glycerin or milk. 

When the stomach is atonic and its powers of absorption impaired, 
the addition of some irritant or stimulant, such as capsicum, will often 
aid in the absorption of the necessary drug. 



COMB IN A TION OF BE UGS FOB JOINT EFFECT. 35 



DURATION OF ACTION OF DRUGS. 

The duration of the action of drugs depends partly upon their rapidity 
of absorption, but chiefly upon the rapidity or slowness of their destruc- 
tion in the body or their elimination from it. Thus, volatile substances, 
such as ether, chloroform, and nitrite of amyl, act only for a short time 
and are quickly eliminated; whereas bromide of potassium and digitalis 
continue active during many hours, and are slowly eliminated, as in 
the case of the former, or oxidized, as in that of the latter. Again, if 
curare is given hypodermically it will cause paralysis, but if taken by 
the stomach in moderate amount it will be eliminated by the kidneys 
as rapidly as it is absorbed, and produce no effects if these organs are 
active. 

From studying the rapidity of the elimination of a drug we learn 
how often to order a dose. Thus, digitalis may be given once, twice, or 
thrice a day, but carbonate of ammonium every two or three hours. 

When the physician is not careful in the use of a potent drug which 
is eliminated slowly, it may suddenly develop so severe an effect as 
to cause alarm, owing to its accumulation in the body. This is 
called "cumulative action." 

COMBINATION OF DRUGS FOR JOINT EFFECT. 

The study of the physiological action of drugs has aided very 
greatly in improving our therapeutic measures, Thus, we now know 
that chloral is a heart-depressant and cannot be used in very full doses, 
or pushed to produce sleep in persistent insomnia, without grave 
danger; whereas morphine, which also produces sleep, but does not 
depress the heart, but does depress the respiration, can be combined 
with it, and the two acting together, each in small dose, produce a 
heavy sleep, although so little chloral is present that the heart is safe, 
and so small an amount of morphine is used that the respiration does 
not suffer. 

Another example of this is found in certain purgative pills where 
the purgative agent is assisted by belladonna and nux vomica, the first 
of which relaxes muscular spasm, while the second acts as a tonic to 
the alimentary tract, the drugs combining to accomplish one result. 

Skill in the combination of drugs, not only for increased physiological 
effect, but also for the purpose of making their administration pleasant 
to the taste, has much more to do with professional success than is 
generally supposed. This is particularly so in regard to children, for 
parents dislike forcing their children to take doses which they them- 
selves regard as unpleasant, and they are ever ready to believe that as 
long as a medicine tastes good it is better than one which tastes other- 
wise. 

The medical practitioner who prescribes never so wisely and appro- 
priately for a patient, but who is utterly regardless as to his combina- 



36 GENERAL THERAPEUTICAL CONSIDERATIONS. 

tions of drugs so far as taste is concerned, will sooner or later see a 
more ignorant man take from him that practice which his greater 
wisdom entitles him to, but which is driven from him by his own errors 
in this matter. 

While in some cases there is no alternative but to give an unpleasant 
dose, in others a little thought and care will often avoid offending the 
taste of the patient. 

STRENGTH AND RELIABILITY OF DRUGS. 

If a census could be made of those who die annually from the use 
of drugs which are impure or useless from weakness, the writer believes 
that a most alarming array of figures would be presented. For many 
years this was unavoidable to a great degree, either because our knowl- 
edge of the active principles of drugs and the methods of isolating them 
was deficient, or because the time consumed in their transportation 
by sailing vessels or on the backs of natives from the countries in which 
the natural products yielding the drugs were obtained, permitted 
deterioration to take place. At present these difficulties have been 
largely overcome. The trained pharmacist is taught how to make an 
assay for active principles in most of the valuable alkaloidal drugs, 
and every physician should make careful investigation into the quality 
of all preparations which he employs. That these remarks are not 
out of place will be seen by the fact that not long since an intimate 
friend of the writer bought from five of the leading druggists of Phila- 
delphia six ounces of tincture of nux vomica which were stated to have 
been made according to the directions of the United States Pharma- 
copoeia. That made by perhaps the leading druggist of the five con- 
tained twice as much strychnine and brucine as it should, and had 
twice as much solid residue; or, in other words, a physician prescribing 
this tincture in full dose would probably have poisoned his patient 
and reported the case as one of unusual susceptibility to drugs! On 
the -other hand, the author has recently seen a tincture of nux vomica 
which contained only a trace of alkaloid, but had much inert solid 
residue. In neither instance was the druggist dishonest intentionally, 
but one had used a crude drug which was unusually rich in alkaloids, 
while the other had purchased nux vomica beans which, by reason of 
immaturity, bad surroundings, or exposure to weather, were very poor 
in active principles. All these disadvantages may be avoided if physi- 
cians will insist that the druggists who dispense the drugs they order 
shall either themselves prepare assayed products, or purchase such 
products from any one of the large manufacturing chemists who put 
assayed goods on the market. When this is impossible, the physician 
should employ the alkaloids in pill form, or, if solutions are desirable, 
the alkaloid may be added to alcohol or water and given by drops, as 
is the case with any ordinary tincture. Digitalis, veratrum viride, and 
ergot are practically the only drugs of importance of which an assay 



IDIOSYNCRASY. 37 

cannot be made; in the first and third the action of the drug does 
not depend upon a single active principle, but upon a number difficult 
of assay, and in the second the relative proportions of jervine and 
veratroidine cannot well be estimated. All drugs should be physiolog- 
ically tested when their chemical assay is impossible. Not long since 
several thousand pounds of ergot were found to be worthless on being 
tested physiologically by one firm; but it was put on the market never- 
theless, for certain manufacturers do not employ this method of exam- 
ination. Constant uncertainty is a dangerous element when dealing 
with patients who are desperately ill; and in many cases failure and 
discouragement may both be avoided if the physician will see to it 
that the drugs which he administers are capable of doing what he 
requires of them. A poor drug to the physician is worse than a rusty 
knife to the surgeon; for the injury in the one case is unknown, while 
in the other it can be carefully watched and guarded. 

IDIOSYNCRASY. 

This is one of the most interesting features of the study of the action 
of drugs. It is a frequent cause of disappointment to both patient 
and physician, and an equally frequent cause of excessive action from 
what the medical attendant has thought to be a moderate dose. No 
rule can be laid down for the discovery of idiosyncrasy in a given case, 
except that females, particularly of the hysterical type, are more sub- 
ject to it than are males, although certain men often present marked 
evidences of this tendency. No better illustration of idiosyncrasy can 
be adduced than the case which here follows, nor than that of a friend 
of the author who cannot eat a strawberry without suffering from a 
violent attack of hives. 

The first case is that of a woman of thirty years, suffering from 
severe headache, who received an eighth of a grain of the hydrochlorate 
of pilocarpine, hypodermically, every twenty minutes, until nearly 
three-fourths of a grain was taken, without any evidence of its action 
either in salivary flow or sweat. But the tolerance of drugs did not 
stop here. Twenty drops of tincture of cannabis indica every four 
hours failing to relieve the pain, half -grain pills of the solid extract were 
ordered, two of which commonly affect a grown man most markedly. 
The extract had been proved to be active to other patients. In order 
to avoid any failure in absorption the pills were each cut in half before 
they were given, and forthwith administered, one every three hours, 
without any effect after ten had been taken. Twenty more of the pills 
from the same manufacturers, but from a different retailer, were now 
given, one every hour with the exception of a few irregularities in 
administration during the night, the entire twenty being swallowed 
between four o'clock one afternoon and two o'clock the next after- 
noon. The thirty pills (fifteen grains) were taken in less than forty- 
eight hours without producing a single physiological sign of the slightest 



38 GENERAL THERAPEUTICAL CONSIDERATIONS. 

character. That the doses were really swallowed would seem to be 
undoubted, for their administration was carried out by a trained 
attendant, and their black color forbade their expulsion from the 
mouth on the bed without attracting attention. The hypodermic 
injections were given by the author, and, as the solution was used as 
fast as it was made, the patient must certainly have received all of 
the pilocarpine. As there was daily an afternoon rise of temperature 
amounting to several degrees, quinine bisulphate was ordered in the 
dose of fifteen grains, to be given after six powders of one-sixth of a 
grain of calomel had been taken; this not only failed to control the 
fever, but also produced no buzzing in the ears. The writer was now 
inclined to consider all the symptoms as hysterical, even including the 
evening rise of temperature. Twenty-four hours after the last dose of 
cannabis indica the attendant gave the patient, without orders, no less 
than sixty grains of antipyrin in sixteen hours without any physio- 
logical symptoms, and, under orders, she took from forty to fifty grains 
of bisulphate of quinine every day for three days without any signs of 
cinchonism. 

Wide experience has taught us, however, that several conditions 
act fairly constantly in regard to some idiosyncrasies. Certain dis- 
eased conditions— such as peritonitis or pain — allow large doses of 
opium to be given, and in lead-poisoning and paralysis patients may 
require enormous doses of active purgatives to move the bowels. 

The climate in which the patient lives, or has been accustomed to 
live, renders him more or less susceptible to certain remedies. Thus 
the East Indian runs amuck after eating hasheesh or cannabis indica, 
or the Chinaman goes into a delightful dreamland from smoking 
opium, whereas the Anglo-Saxon experiences no such agreeable sensa- 
tions, as a general rule. Southerners generally require larger doses 
of purgatives than Northerners, often because their livers are not so 
active. 

The temperament of an individual is also a highly important matter 
to be considered. It is a notorious fact that phlegmatic dark-skinned 
individuals usually yield to drugs less readily than blondes and nervous 
persons, more especially in respect to the drugs which act on the ner- 
vous system. Nervous light-haired women stand belladonna very 
badly as a general rule, while children will take large doses often with- 
out discomfort. Opium is usually badly borne by children. 

Habit is another important factor governing idiosyncrasy. We all 
know how rapidly one becomes accustomed to tobacco, and how 
morphine habitues take enormous amounts of their favorite drug 
without effect. 



INDICATIONS, CONTRAINDICATIONS AND DEFINITIONS. 39 



INDICATIONS AND CONTRAINDICATIONS AND 
DEFINITIONS. 

The indication for a drug is any symptom or series of symptoms 
which we know the drug will relieve without causing at the same 
time an evil effect to be felt by other parts of the body. A contra- 
indication is any coexisting state or tendency which will be made so 
much worse by the drug as to forbid its use. Thus, one might be 
tempted to give quinine in meningitis for the fever, yet this would 
be bad therapeutics, since quinine is contraindicated because it will 
increase the congestion. 

Abortijacients form a class of drugs which, as such, ought never to 
be employed. If pregnancy is to be interfered with, the interruption 
should be produced by instrumental means, and then only after con- 
sultation with another practitioner to get his views and protect one's 
self from possible legal difficulties. 

Alteratives are indicated where cell-growth is active to excess, but 
contraindicated where tissue break-down is present, or there exists a 
tendency thereto. 

Anesthetics are used to abolish sensation. They are either local or 
general. Many of the local anaesthetics produce loss of sensation 
through benumbing the parts by the cold they produce. Cocaine 
is an example of a local anaesthetic which causes anaesthesia by a 
direct paralyzant action on the peripheral sensory nerves. The general 
anaesthetics are taken by inhalation and act upon the higher centres 
in the brain. 

Anaphrodisiacs are used to diminish sexual desire. 

Antacids are employed in cases where, as a result of morbid pro- 
cesses, lactic and butyric acids, or even hydrochloric acid, are found 
in abnormal quantities in the stomach. 

Anthelmintics are used for the purpose of removing intestinal 
worms. 

Antiarthritics is the name given those drugs which are employed 
for the purpose of relieving inflammations occurring in joints, whether 
these be in an acute or chronic condition of disease. 

Antihydrotics are used to prevent excessive sweating, either local 
or general. Camphoric acid is probably the best general antihydrotic. 

Antiperiodics is a term applied to drugs or remedies employed for 
the prevention or cure of malarial poisoning. They are so named 
because they tend to diminish or arrest the periodicity of the attacks, 
which periodicity is a characteristic of such diseases. 

Antiphlogistics are employed to prevent the progress of inflam- 
matory processes. They axe nearly all contraindicated in the presence 
of tissues possessing impaired vitality through previous conditions of 
disease. 

Aphrodisiacs are used to increase sexual desire and power. 



40 GENERAL THERAPEUTICAL CONSIDERATIONS. 

Astringents are employed for the purpose of contracting or con- 
stringing tissues. They act either by coagulation of albumin, by pre- 
cipitating albumin, or by making the tissues more dense by concentra- 
tion. Theoretically, all astringents should be non-irritating, but 
practically they possess irritant properties, and are, in consequence, 
contraindicated in the presence of very acute inflammations as a rule. 
Three of the mineral astringents, however, possess marked sedative 
properties in addition to their astringent power, and can therefore be 
used freely in acute inflammations when locally applied. They are 
nitrate of silver, subacetate or acetate of lead, and the subcarbonate 
or subnitrate of bismuth. 

Bitters are designed to increase the activity of the mucous mem- 
brane of the gastro-intestinal canal by increasing its tone. They 
may be divided into simple bitters and complex bitters. The first 
depend upon their bitterness solely for their activity; the second class is 
well represented by quinine and strychnine, both of which are exceed- 
ingly bitter, but, in addition to their local effect on the gastro-intestinal 
mucous membrane, act as stimulants to other portions of the organism. 
A good example of a simple bitter is columbo. Many bitters contain 
so much tannic acid that they are not generally useful, and for this 
reason very few can be used with preparations of iron, since a tannate 
of iron would be formed. 

Cardiac sedatives decrease the force of the heart, and, as a class, 
the amount of blood expelled at each beat of the ventricles. They 
are indicated in arterial excitement, and contraindicated in arterial 
depression. 

Cardiac stimulants increase the force of the heart, thereby increas- 
ing the quantity of blood expelled from the ventricles. Their effect 
may be accomplished by an increase in the rapidity of the beats or 
by a greater output of blood at each contraction, the diastole being 
sufficiently prolonged to admit of the ventricles being well filled. 
They are contraindicated in the presence of arterial excitement, and 
indicated in arterial depression. 

Carminatives are given for the purpose of expelling flatus, particu- 
larly if there is reason to believe that the "wind" has accumulated 
because of intestinal torpidity. Many of the carminatives are neces- 
sarily possessed of irritant properties, and are therefore contraindicated 
in the presence of flatulence due to intestinal atony arising from 
inflammation. The best carminative is spiritus setheris compositus, 
or Hoffmann's Anodyne. 

Cathartics. — These are drugs employed when a positive and decided 
action of the bowels is desired. They occupy a position between the 
purges and the drastics. (See Purges and Drastics.) A good example 
of a cathartic is senna when given in full dose. 

Cholagogues are used to exert a stimulant influence over the flow of 
bile. Nitro-hydrochloric acid and mercury bichloride are perhaps 
the best types of pure cholagogues, while podophyllum and calomel 



INDICATIONS, CONTRAINDICATIONS AND DEFINITIONS. 41 

represent the class of cholagogues which increase intestinal peristalsis 
in addition to stimulating the flow of bile. Cholagogues are, as a rule, 
contraindicated in the presence of acute inflammation of the gall- 
bladder or liver. 

Counterirritants are used to produce irritation at a spot distant 
from a painful or inflamed area, in order to relieve the diseased parts 
by reflex action exerted through the nervous system upon the painful 
nerve or disordered capillary network. 

Demulcents are used to protect from irritation any exposed parts of 
the body. 

Diaphoretics produce an increased secretion from the sweat-glands. 
They may be considered as internal and external. The internal are 
represented by pilocarpine, which stimulates the sweat-glands them- 
selves; the external are represented by the Turkish and Russian baths, 
which, by increasing bodily heat and dilating bloodvessels, cause a 
profuse sweat. 

Diuretics are used to increase the flow of urine from the kidneys. 
They act by stimulating the renal epithelium to greater activity, 
thereby increasing the excretion of both the watery and solid con- 
stituents of the urine ; or they simply increase the watery constituents 
by increased blood-pressure in the kidney. 

It is to be remembered that the vegetable salts of potassium and 
the lithium salts increase the solids in the urine, not by stimulating 
the secreting epithelium of the kidney, but by uniting with insoluble 
material in the system, forming soluble compounds which are then 
readily eliminated. (See Eliminators.) They are indicated in con- 
ditions of renal inactivity due either to functional or organic causes. 
Irritating diuretics, such as cantharides, for example, are contraindi- 
cated in acute nephritis. Such a diuretic is only to be used where the 
kidneys are inactive through atony or prolonged chronic or subacute 
disease. 

Eliminators are drugs which, by forming soluble compounds with 
insoluble substances in the body, render them capable of being excreted 
by the excretory organs, such as the skin, kidneys, and bowels. 

Emetics are used to produce vomiting. They act centrally when, 
as is the case with apomorphine, they stimulate the vomiting centre; 
peripherally when they irritate the walls of the stomach. They 
are indicated when we wish to unload the stomach of undesirable 
materials, or when we desire to cause an increased flow of bile from 
the gall-bladder, which is accomplished by the pressure exerted upon 
this viscus when the abdominal walls and diaphragm contract in 
retching. When the ducts are mechanically obstructed by a gallstone 
emetics are dangerous, as they may cause rupture of the gall-bladder. 

Sometimes we are able by the use of emetics to rid the lungs and 
stomach of mucus in bronchitis or gastric catarrh. 

The contraindications to emetics are cerebral congestion or menin- 
gitis, gastritis, gastric ulcer, advanced pregnancy, and hernia. 



42 GENERAL THERAPEUTICAL CONSIDERATIONS. 

Emmenagogues are used to produce or increase the menstrual 
flow. They are of two classes — direct and indirect. The direct are 
most of them irritants, and are seldom of much value; the indirect 
are used to overcome the morbid condition underlying the men- 
strual disorder, and are therefore more rational. Thus iron and 
arsenic may be used with beneficial result in amenorrhcea due to 
anaemia. 

Expectorants are employed when it is desirable to promote secretion 
or to get rid of secretion in the bronchial tubes. Thus, in the early 
stages of an acute bronchitis the mucous membrane is hyperaemic 
and swollen, but dry and irritable. Ipecac and citrate of potassium 
form at this time a sedative expectorant mixture, which, while allay- 
ing irritation, promotes secretion and so relieves the engorged area. 
On the other hand, after the acute stage is passed, there may be so 
much atony of the mucous glands that the secretion is either too scanty 
or too viscid to be coughed up. Stimulant expectorants, such as 
chloride of ammonium, eucalyptus, and terebene, are now to be em- 
ployed. These latter drugs are contraindicated in the acute inflam- 
matory stage of the disease, as they would simply stimulate the 
mucous membrane to greater irritation. 

Hypnotics are used to produce sleep. They may be divided into 
those which produce sleep and relieve pain, and those which have 
no analgesic power. The latter are therefore not to be employed in 
sleeplessness due to pain, and the former are contraindicated when 
pain is absent. Thus, chloral produces sleep if it be ordinary func- 
tional insomnia; but if the sleeplessness is due to pain, opium is 
the drug to be employed. Chloral, in ordinary doses, is the purest 
hypnotic that we have. 

Mydriatics produce dilatation of the pupil, or mydriasis. Condi- 
tions of the eye associated with increased intraocular tension are 
contraindications to mydriatics, as a rule. 

Myotics cause contraction of the pupil or myosis. They are best 
represented by eserine. 

Nervous sedatives are indicated and contraindicated in a reverse 
manner to nervous stimulants. 

Nervous stimulants are contraindicated in nervous excitement, and 
indicated in nervous depression. 

Oxytoxics increase the expulsive power of the uterine muscular 
tissues. 

Revulsives are used to produce increased activity of the general 
system or parts thereof through reflex influences — that is, they cause 
a determination of blood to one part, thereby relieving an engorged 
area. Thus, in cerebral congestion or effusion a vigorous purgative 
or cathartic may give relief by exercising a derivative effect. Revulsives 
are closely allied to counterirritants. 

Roborants are devoted to the repair and building up of tissues in 
the body, and comprise both food and drugs. Roborant treatment 



INCOMPA TIBILITY. 43 

also includes hygienic surroundings, fresh air, light and healthful 
employment. 

Tonics are used to increase vital activity. They are indicated in 
local or general, systemic depression, and contraindicated in cases of 
inflammation or excitation with excessive functional activity. (See 
Bitters.) 

Vasomotor depressants decrease arterial pressure by an action on 
the vasomotor nervous system rather than by an action on the heart. 
They act by relaxing the bloodvessels. 

Vasomotor stimulants increase arterial pressure by an action on 
the vasomotor system, thereby producing contraction of the blood- 
vessels. 



INCOMPATIBILITY. 

One of the uses of a knowledge of chemistry and pharmacy to a prac- 
titioner of medicine is the avoidance of what is known as an ''incom- 
patibility/' or the placing in a prescription of two or more substances 
which will undergo chemical interchanges, decompositions, precipita- 
tions, or cause the formation of explosive mixtures. It is impossible 
to detail all the incompatibilities, and only the most dangerous and 
common possibilities of error can be considered: 

1st. An acid should never be combined with an alkali. 

2d. A strong acid should not be added in any quantity to a tincture. 
The following prescription is an illustration of this : 

Jy — Potassii iodidi o i j - 

Acidi nitro-muriatici f5j- 

Ti\ cinchonse comp q. s. fSiij. — M. 

S. — Use as directed: a teaspoonful. 

In this ridiculous mixture the acid is incompatible with the iodide 
of potassium, forming a chloride and setting free iodine, and would 
also change part of the alcohol in the tincture into an ether. 

3d. Alkalies and neutral bases should not be combined with the 
alkaloidal salts. 

1^ — Strychninae sulph. . gr. j. 

Potassii iodidi 5ij. 

Syr. sarsaparillse comp. fBiij. — M. 

S. — Teaspoonful t. i. d. 

In this prescription the strychnine would be precipitated by the 
potassium salt, and the patient would get nearly all the strychnine in 
the last dose. 

4th. Potassium chlorate should not be ordered to be rubbed up with 
tannic acid nor any other organic substance capable of oxidation, as it 
will explode. Permanganate of potassium is subject to the same rule. 



44 GENERAL THERAPEUTICAL CONSIDERATIONS. 

5th. Chlorate of potassium and ammonium chloride when mixed 
together may ignite. 

6th. Iron is incompatible with tannic acid, as it forms a tannate of 
iron, or ink. As all the vegetable astringents contain tannic acid, they 
should none of them be used with iron except chiretta and columbo. 

7th. Tannic acid should never be added to solutions of alkaloids. 

8th. Gum arabic is not to be added to solutions of iron, lead, or 
the mineral acids. 

9th. Alcoholic solutions of camphor and similar resinous substances 
are incompatible with water. 

10th. Fluid extracts are incompatible with water, as the addition of 
water will precipitate them. 

11th. All salts not acid but alkaline in reaction are decomposed by 
acids. 

12th. All salts which are acid are decomposed by alkalies. 

13th. All vegetable acid salts are altered by mineral acids and are 
decomposed by alkalies. 

14th. Iodine and the iodides should not be given with alkaloids. 

15th. Corrosive sublimate, the salts of lead, iodide of potassium, and 
nitrate of silver should always be prescribed alone, except in the follow- 
ing instances: 

(a) Corrosive sublimate may be given with potassium iodide, since 
it will throw down a precipitate which redissolves and forms a double 
salt. 

(6) Nitrate of silver maybe used with extract of opium or hyoscyamus. 

16th. Syrup of squill should not be given with the carbonate of 
ammonium, as it contains acetic acid. Chloride of ammonium is not 
incompatible with it. 

17th. Cherry-laurel water should not be prescribed with morphine, 
as it may form the poisonous cyanide of morphine. 

18th. Chloral and cyanide of potassium should never be placed in 
the same prescription, as they will decompose each other, setting free 
hydrocyanic acid. 

19th. Cocaine and borax when added together form an insoluble 
borate of cocaine. Boric acid and cocaine do not result in this forma- 
tion. 

20th. Calomel and antipyrin are incompatible, as are also sweet spirit 
of nitre and antipyrin. 

21st. Waters cannot be used in preparing saturated solutions of drugs, 
as they are already loaded with the volatile substance. 

22d. Pepsin and pancreatin should not be used together, since the 
former can only act in an acid and the latter in an alkaline medium, 
and the pancreatin is destroyed by the acid gastric digestive process 
Further, one ferment may neutralize the other. 



CLASSIFICATION OF DRUGS. 



45 



THE IMPORTANCE OF DIETETIC TREATMENT. 

Many physicians fail to pay proper attention to the regulation of the 
diet when treating those who are ill or "out of sorts." As a matter of 
fact, the administration of medicine often fails to produce good results 
simply because the patient, by persisting in the use of improper food 
and drink, is perpetuating the difficulty of which he is trying to get rid. 
There is scarcely a case in which some regulation or alteration of the 
diet will not be of advantage to the sick man. (See Foods for the Sick.) 
Further than this, failure to give directions as to diet is apt to give the 
patient the idea that the physician is careless, whereas care in this 
respect will greatly enhance his estimate of the physician's ability to 
attend to important details of the case. 

CLASSIFICATION OF DRUGS. 

In order that the student may gain a definite idea as to the various 
actions of different remedies the following list of drugs is appended, 
which is of necessity somewhat arbitrary, and is not intended to be 
exhaustive, for many remedies might be placed in several classes. 
The endeavor has been made to place the best or most powerful drug 
of each class first in the list. It is to be remembered that a strict 
physiological classification is impossible. 



'. Alteratives. 




III. Antacids. 


1. Mercury. 




1. Ammonia. 


2. The iodides of potassium 


and so- 


2. Sodium and its salts. 


dium. 




3. Liquor potassse. 


3. Iodine. 




4. Magnesia. 


4. Iodoform. 




5. Lime. 


5. Iodol. 






6. Arsenic. 

7. Cod-liver oil. 




IV. Anthelmintics. 


8. Colchicum. 




Those that are used against the round 


9. Ichthyol. 




worm are — 


10. Taraxacum. 




1. Santonica. 


11. Mezereum. 




2. Spigelia. 


12. Nuclein. 




3. Chenopodium. 

4. Azedarach. 


I. Anesthetics. .. 




5. Santoninate of sodium. 


1. Ether. 






2. Nitrous oxide gas. 

3. Chloroform. 








Those used against the tape-worm are— 


4. Cocaine. 


* 


1. Pelletierine. 


5. Eucaine. 




2. Aspidium. 


6. Bromide of ethyl. 




3. Pepo. 


7. Chloride of ethyl and of methvl. 


4. Pomegranate. 


8. Pental. 




5. Brayera. 


9. Bromoform. 




6. Kamala. 


10. Carbolic acid. 




7. Turpentine. 


11. Antipvrin. 




8. Chloroform. 


12. Menthol. 







46 



GENERAL THERAPEUTICAL CONSIDERATIONS. 



Those used against the seat-worm, or 
Oxyuris verraicularis, are — 

1. Quassia. 

2. Turpentine. 

3. Tannic acid. 

4. Chloride of sodium. 

5. Vinegar. 

V. Antiseptics. (See also Disinfect- 

ants. ) 

1. Corrosive sublimate in weak so- 

lutions. 

2. Carbolic acid in weak solutions. 

3. Peroxide of hydrogen. 

4. Creolin. 

5. Lysol. 

6. Boric acid. 

7. Permanganate of potassium. 

8. Salicylic acid. 

9. Sulphate of iron. 

VI. Antipeuiodics or Antimalarials. 

1. Cinchona. 

2. Eucalyptus. 

3. Warburg's tincture. 

4. Arsenic. 

5. Methylene blue. 

VII. Antipyretics. 

1. Antipyrin. 

2. Acetanilid or antifebrin. 

3. Phenacetin. 

4. Guaiacol. 

5. Phenocoll. 

6. Quinine. 

7. Salicylic acid. 

8. Thallin. 

9. Carbolic acid. 
10. Kairin. 

VIII. Antispasmodics. 

1. Amyl nitrite. 

2. Chloral. 

3. Bromides. 

4. Opium. 

5. Belladonna. 

6. Camphor. 

7. Hoffmann's anodyne. 

8. Asafoetida. 

9. Musk. 

10. Valerian. 

11. Monobromated camphor. 

12. Amber. 

13. Cimicifuga. 

14. Hops. 

IX. Astringents. 

Vegetable : 

1. Tannic acid. 

2. Hsematoxylon. 

3. Kino. 

4. Catechu. 

5. Rhatany or krameria. 

6. Rhus glabra. 

7. Geranium. 



8. White oak. 

9. Black oak. 

10. Gallic acid. 

11. Rosa centifolia. 

12. Rosa gallica. 

All of these depend chiefly upon tannic 

acid for their active principle. 
Mineral : 

1. Sulphuric acid. 

2. Alum. 

3. Lead. 

4. Nitrate of silver, 

5. Nitric acid. 

6. Sulphate of copper. 

7. Bismuth. 

8. Sulphate of zinc. 

X. Cardiac Sedatives. 

1. Aconite. 

2. Veratrum viride and album. 

3. Antimony. 

4. Hydrocyanic acid. 

5. Veratrum sabadilla. 

XL Cardiac Stimulants. 



1. 


Digitalis. 


2. 


Strophanthus. 


3. 


Ammonia. 


4, 


Ether. 


5. 


Alcohol. 


6. 


Caffeine. 


7. 


Nux vomica. 


8. 


Ignatia. 


9. 


Adonis vernaiis. 


10. 


Convallaria majalis. 


11. 


Sparteine. 


12. 


Amyl nitrite (momentarily) 


13. 


Opium. 



XII. Counter-irritants. 

Those counter-irritants that blister are 
called epispastics. They are — 

1. Cantharides. 

2. Thapsia. 

3. Ammonia or chloroform when 

under a watch-glass. 

Those that redden or produce local 

hyperemia of the skin are — 

1. Mustard. 

2. Capsicum. 

3. Turpentine. 

4. Ammonia. 

5. Chloroform. 

6. Burgundy pitch. 

7. Canada pitch. 

8. Most of the spices. 

Under the name of Escharotics are 
grouped a number of substances 
capable of acting as "destructive 
agents upon the soft tissues of the 
body. They are — 

1. Chromic acid. 

2. Nitric acid. 



CLASSIFICATION OF DRUGS. 



47 



10. 

11. 

12. 



Sulphuric acid. 

Nitrate of mercury (solution), 

Bromine. 

Caustic potash. 

Caustic soda. 

Burnt alum. 

Arsenous acid. 

Chloride of zinc. 

Vienna paste. 

Canquoin's paste. 



XIII. Diaphoretics. 

The only ones that we know as direct 
stimulants to the glands are — 

1. Pilocarpus or jaborandi. 

2. Warburg's tincture. 

The others are — 

3. Hot dry and hot moist baths. 

4. Dover's powder. 

5. Alcohol (particularly when hot). 

6. Nitrous ether. 

XIV. DlGESTANTS. 

1. Pancreatin. 

2. Pepsin. 

3. Hydrochloric acid. 

4. Diastase. 

5. Papain. 

XV. Disinfectants. 

1. Corrosive sublimate. 

2. Chlorine or chlorinated lime. 

3. Formaldehyde. 

4. Carbolic acid. 

5. Chloride of zinc. 

XVI. Diuretics. 

Those that increase both the solids and 
liquid constituents are probably — 

1. Caffeine. 

2. Squill. 

3. Cantharides. 

4. Buchu. 

5. Vegetable salts of potassium. 

6. Lithium. 

7. Juniper. 

8. Turpentine. 

9. Uva ursi. 

10. Chimaphila. 

11. Cubebs. 

12. Pareira brava. 

13. Blatta. 

Those which increase the watery con- 
stituents of the urine without in- 
creasing the solids proportionately 
are — 

1. Digitalis. 

2. Nitrous ether. 

XVII. Elimi natives. 
1. The iodides. 



2. The salicylates. 

3. The vegetable salts of potassium 

and the purgatives. 

4. The lithium salts. 

5. Jaborandi. 

6. Colchicum (probably). 

XVIII. Emmenagogues. 

The direct emmenagogues are — 

1. Apiol. 

2. Binoxide of manganese. 

3. Permanganate of potassium. 

4. Cantharides. 

5. Aloes. 

6. Myrrh. 

7. Kue. 

8. Savine. 

9. Tansy. 

10. Pennyroyal. 

11. Guaiac. 

The indirect are — 

1. Iron. 

2. Arsenic. 

3. Copper. 

4. Tonics in general. 

XIX. Emetics. 

The direct are represented by — 

1. Apomorphine. 

2. Ipecac (which is both centric and 

peripheral). 

3. Tartar emetic (which is both 

centric and peripheral). 

The peripheral are — 

1. Sulphate of zinc. 

2. Mustard. 

3. Alum. 

4. Sulphate of copper. 

5. Turpeth mineral. 

XX. Expectorants. 
Sedative : 

1. Citrate or acetate of potassium. 

2. Ipecac. 

3. Antimony. 

4. Lobelia. 

Those which act as stimulating expeo 
torants are — 

1. Ammonium chloride. 

2. Apomorphine. 

3. Creasote. 

4. Eucalvptus. 

5. Tar. 

6. Terebene. 

7. Terpine hydrate. 

8. Oil of sandal-wood. 

9. Sulphur. 

10. Grindelia robusta, 

11. Garlic. 

12. Squill. 



48 



GENERAL THERAPEUTICAL CONSIDERATIONS. 



Besides these we have nux 


vomica, 


1 3 - 


Coca. 


which increases expectoration by stimu- 


4. 


Kola. 


lating the nervous system to coughing, 


5. 


Caffeine. 


and thus expels the mucus. Opium and 






the bromides depress the nervous system 


XXIV. 


Oxytocics. 


and allay cough, and so decrease 


expecto- 


1. 


Ergot. 


ration. 




2. 


Cotton-root. 


XXI. Hypnotics. 




3. 


Ustilago maydis. 


1. Chloral. 




And indirect when in labor : 


2. Bromides of potassium, 


sodium, 


1. 


Quinine. 


etc. 




2. 


Kola. 


3. Opium. 








4. Sulphonal. 




XXV. 


Purgatives. 


5. Trional. 

6. Tetronal. 




Laxatives : 


7. Paraldehyde. 




1. 


Cascara sagrada. 


8. Chloralose. 




2. 


Sulphur. 


9. Chloralamide. 




3. 


Rhubarb. 


10. Hypnal. 




4. 


Frangula. 


11. Hyoscine (in mania). 




5. 


Cassia fistula. 


12. Duboisine (in mania). 




6. 


Euonymus. 


13. Cannabis indica (in large 


dose). 


7. 
8. 


Magnesia. 
Manna. 


XXII. Nervous Sedatives. 




9. 


Fruits. 


1. Chloral. 

2. Opium (in full doses). 




Cathartics (mineral) : 


3. The bromides and hydrobromic 


1. 


Magnesium sulphate. 


acid. 




2. 


Magnesium citrate. 


4. Chloroform. 




3. 


Sodium phosphate. 


5. Amyl nitrite. 




4. 


Potassium and sodium tartrate. 


6. Nitrites of potassium and sodium, 


5. 


Sodium sulphate. 


and nitroglycerin. 




6. 


Mercury. 


7. Ether. 

8. Bromide of ethyl. 




Cathartics (vegetable): 


9. Nitrous oxide. 




1. 


Castor oil. 


10. Bromoform. 




2. 


Senna. 


11. Belladonna. 




3. 


Aloes. 


12. Antipyrin. 




4. 


Podophyllin. 


13. Acetanilid. 

14. Phenacetin. 




Cathartics (hydragogue) : 


15. Calabar bean. 




1. 


Elaterium. 


16. Hydrocyanic acid. 




2. 


Jalap. 


17. Lobelia. 




3. 


Colocynth. 


18. Conium. 




4. 


Croton oil. 


19. Cannabis indica. 




5. 


Gamboge. 


20. Sulphonal. 




6. 


Scammony. 


21. Croton chloral. 




7. 


The saline purgatives, if co 


22. Paraldehyde. 






centrated solutions are used. 


23. Camphor. 








24. Monobromated camphor. 




XXVI. 


Tonics. 


25. Asafcetida. 




1. 


Cinchona. 


26. Amber. 




2. 


Nux vomica. 


27. Hoffmann's anodyne. 




3. 


Calumba. 


28. Cimicifuga. 




4. 


Arsenic. 


29. Musk. 




5. 


Phosphorus. 


30. Valerian. 




6. 


Mercury (in minute doses). 


31. Humulus. 




7. 


Copper. 


32. Castor. 




8. 


Iron. 


33. Hypnal. 




9. 


Hydrochloric acid. 


34. Tobacco. 




10. 


Nitro-hydrochloric acid. 
Nitric acid. 
Phosphoric acid. 


XXIII. Nervous Stimulants, 




11. 
12. 


1. Nux vomica. 




1-3. 


Coridurango. 


2. Ignatia. 




14. 


The vegetable bitters in general 



PRESCRIPTION WRITING. 



49 



XXVII- Vasomotor Depressants. 


XXVIII. Vasomotor Stimtjxants 


1. Amyl nitrite. 




1. Belladonna. 


2. Nitroglycerin and other nitrites. 


2. Hyoscyamus. 


3. Veratrum viride. 




3. Digitalis. 


4. Antimony. 




4. Nux vomica. 


5. Aconite. 




5. Ergot. 


6. Veratrum album. 




6. Stramonium. 


7. Veratrum sabadilla. 




7. Caffeine. 


8. Alcohol (in excessive 


doses). 


8. Convallaria. 


9. Jaborandi. 




9. Suprarenal gland. 



PRESCRIPTION WRITING. 

When a physician directs a patient how to regulate his diet, what 
exercise he is to take, and how many hours a day are to be devoted to 
recreation and work, he prescribes for him quite as much as when he 
writes a prescription calling for one or more drugs which are to be 
dispensed by the druggist and swallowed by the individual who is 
ailing. Nevertheless, the word "prescription" is usually applied to 
the piece of paper on which is written the physician's order to the 
druggist. 

In writing prescriptions physicians usually employ Latin terms. 
There are several reasons for this. In the first place, it is a custom 
which has been followed since the time when medical science was in 
its infancy, and medical men were wont to write what they had to say 
in Latin. Secondly, the botanical names of plants are usually given in 
Latin : first, because scientific men give them their names, and, second, 
because not infrequently the English name for a plant in one part 
of a country has an entirely different application in another. Thus, 
nearly every State has a drug called "Snake-root," yet in each instance 
a different plant may be so designated. Again, it is often advisable 
that a patient be kept in ignorance of the character of the drug which 
he is taking, lest he attempt to use it without a physician's advice 
on another occasion, and thereby do himself injury. Thus the physi- 
cian might wish to give a patient a dose of coca as a powerful nervous 
stimulant, yet would fear that it might be taken without advice later, 
and do harm. By using the word " Erythroxylon " the druggist 
knows what to dispense, but the patient does not recognize the term 
used and fails to remember it. 

All prescriptions should be written on sheets of paper on which are 
printed the physician's name, address, and office hours. This informa- 
tion is obviously necessary, and particularly is it useful to the druggist, 
who may wish to communicate with the physician in case he thinks 
that a poisonous dose has been ordered by mistake. The name and 
address of the patient should be written on the prescription-blank, so 
that the druggist may know where the medicine is to be sent when it 
is prepared. The prescription is to be accurately dated. 

The first symbol or mark placed on a prescription-blank after writing 
the name of the patient and his address is "I$," which stands for 

4 



50 GENERAL THERAPEUTICAL CONSIDERATIONS: 

"Recipe," which is the second person singular of the imperative present 
of the Latin verb "Recipio," meaning "I take." Recipe or fy there- 
fore, says to the druggist "Take thou" of whatever substances the 
physician desires. As he is to take a given quantity of his stock and 
place it in the mixture, the name of the drug is put in the partitive 
genitive case. When, however, a pill or other finished or complete 
product is ordered, so that not part of the stock, but the whole article 
is desired, the name of the medicine is placed in the accusative case, 
since it is the object of the verb. 

The nouns or names of drugs belong to one of the five Latin declen- 
sions, and are most of them declinable. Those of the first declension 
end in the letter "a" in the nominative singular, and in "se" in the 
genitive singular, or "arum" in the genitive plural, except in the case 
of the word aloe, the genitive singular of which is aloes. Thus aqua 
is the nominative, aquas is the genitive singular, and aquarum is the 
genitive plural. 

The nouns of the second declension end either in "us" if masculine, 
or "um" if neuter. Their genitive singular ends in "i" and the geni- 
tive plural in "orum." There are several nouns of this declension 
which end in "on," like "mematoxylon," which also end in "i" in 
the genitive singular. Thus we find that Syrwpus is the nominative, 
Syrupi the genitive singular, and Syruporum the genitive plural. 

In the third declension the nouns end in a, e, i, o, y, c, 1, m, r, s, 
t, and x. The genitive singular ends in "is" and the genitive plural 
in "um." Thus, Miher in the genitive is Miheris, and the genitive 
plural Mtherum. When the noun ends in "s" the genitive takes a 
"t" before the "is." Thus boras is the nominative singular, boratis 
the genitive singular, and boratum the genitive plural. 

In the fourth declension the masculine nouns end in "us," and the 
neuter nouns in "u." The genitive singular of the masculine noun 
ends, as does the nominative, in "us," and the neuter noun like the 
nominative ends in "u," while the genitive plural ends in "um." 
Thus, Spiritus, of which the nominative singular ends in "us," is 
spiritus in the genitive singular, and spirituum in the genitive plural. 

In the fifth declension the nominative singular ends in "es," the 
genitive singular in "i," and the genitive plural in "rum." Thus Res 
has as its genitive singular rei, and as its genitive plural rerum. 

Adjectives used to qualify nouns agree with them in gender, number, 
and case. 

After the ingredients and their quantities have been signified the 
physician expresses his wishes further, and writes the word "Misce," 
"mix" the ingredients. If the prescription is put up in fluid form, 
he next writes the signatura, and writes the word Signa, usually 
abbreviated by Sig., which tells the druggist to write the directions, 
which follow in English, on the label of the bottle. 

If the prescription consists in a powder and is to be put in papers, 
after the word Misce, or the letter "M.," which stands for misce, the 



PRESCRIPTION WRITING. 51 

physician adds et divide in chartulas No. xx. — that is, divide into 
twenty small papers or powders. If pills are desired, he writes 
M. fiant (often written "ft.") in pilulce No. xx. — that is, make into 
20 pills. 

Or fiat unguentum, let an ointment be made. 

Or the imperative may be used by the employment of the word 
fac, as fac swppositorias numero v. — that is, "Make thou 5 supposi- 
tories." 

If capsules are desired, the druggist is directed to mix the ingredients, 
and the physician adds et pone in capsulas No. xx. — that is, mix and 
put into 20 capsules. 

A prescription is often composed of a basis or the drug that is most 
important, an adjuvant or the drug to aid the basis, a corrective to over- 
come some effect which is undesirable, and a vehicle to give bulk and 
to carry the active substances into the body. After the name of the 
vehicle, which is also designed to bring up the mixture to an even 
quantity, we add the words quantum sufficit ad (a sufficient quantity 
to), usually abbreviated to "q. s. ad," to make the number of ounces 
desired. 

A complete prescription may therefore be written as follows: 

For Mr. John Jones, 

111 Blank Street, 

October 31, 1901. 

^ — Bismuthi subnitratis gr. xl. 

Creosoti ..'•■'• n l x - 

Misce et pone in capsulas No. xx. 
Signa. — Take one after each meal. 
Or 

1^ — Acidi sulphurici aromatici . . . . . f 5ij- 
Extracti hsematoxyli fluidi ..... fjiv. 

Spiritus chloroformi fgj. 

Syrupi zingiberis q. s. ad f g iij. 

Misce. 
Signa. — Take 1 dessertspoonful in water every three hours. 

In the last prescription the sulphuric acid is the basis, the hgema- 
toxylon and spirit of chloroform are the adjuvants, and the syrup of 
ginger is the vehicle. 






> 



52 



GENERAL THERAPEUTICAL CONSIDERATIONS. 



CHANGES IN THE STRENGTH OF OFFICIAL TINCTURES IN THE 

U. S. P. OF 1905. 

Name. 

Aconite . 

Belladonna leaves 

Calumba 

Cannabis Indica 

Cantharides 

Capsicum 

Cardamom 

Cinnamon 

Colchicum seed 

Digitalis 

Gelsemium 

Hyoscyamus . 

Kino 

Lobelia . 

Physostigma . 

Quassia . 

Rhubarb 

Sanguinaria 

Squill 

Serpentaria 

Stramonium . 

Strophanthus . 

Tolu 

Veratrum viride 

Tincture of nux vomica (1905) will contain 1 grm. of strychnine in 
1000. 

It will be noted that the strength of all the tinctures of powerful 
drugs is 10 per cent, of the crude drug except tincture of nux vomica, 
which is 1 of alkaloid per 1000 of tincture. 



Grms. of drug in 


1000 c.c 


1900. 


1890. 


100 


350 


100 


150 


200 


100 


100 


150 


100 


50 


100 


50 


200 


100 


200 


100 


100 


150 


100 


150 


100 


150 


100 


150 


50 


100 


100 


200 


100 


150 


200 


100 


200 


100 


100 


150 


100 


150 


200 


100 


100 


150 


100 


50 


200 


100 


100 


400 



PAET II. 

DRUGS. 

ACACIA. 

Acacia, U. S., Acacice Gummi, B. P., Gum Arabic or Gum Acacia, 
is a gummy exudate from the stems and branches of small trees known 
as Acacia Senegal, and other acacias growing in Northern Africa and 
in Australia. As sold in the stores it consists of irregular semitrans- 
parent lumps, which are either smooth or angular, according to whether 
the substance has been preserved in the original beads or broken by 
handling. Its color is slightly yellow or almost white, both color and 
transparency depending largely on the amount of the impurities by 
which it is contaminated. 

Acacia is devoid of physiological action. 

Therapeutics. — Acacia is employed in medicine as a local applica- 
tion to inflamed and irritated mucous membranes, particularly of the 
upper air-passages, and also when dissolved in water in the form of a 
drink when the same conditions exist in the mucous membranes of the 
alimentary canal and genito-urinary tract. In all these states it is use- 
ful as a vehicle for more powerful remedies. Made into a mucilage 
with flaxseed, to which liquorice may be added, it is largely employed 
as a drink to loosen a hacking cough in children or in adults. The 
flaxseed should not be boiled, but allowed to stand on a moderately 
warm part of the " range," and the gum-arabic solution added with 
a little lemon-juice for flavoring purposes. Acacia is chiefly used in 
pharmacy for making pills, emulsions, and similar preparations, and 
is official in the form of the mucilage of acacia (Mucilago Acacia?, 
U. S. and B. P.) and the syrup of acacia (Syrupus Acacia?, U. S.), the 
first containing 340 grms. of acacia, lime-water 330 grms., and water 
enough to make 1000 grms., and the second 25 c.c. of the mucilage to 
75 c.c. of syrup. 

ACETANILID, or ANTIFEBRIN. 

Acetanilidum, U. S. and B. P., is a white crystalline material only 
slightly soluble in water, but completely soluble in alcohol and ether. 
Applied to the tongue, it causes a slight burning sensation. It is 
made by the action of glacial acetic acid upon aniline, forming aceta- 

(53) 



54 DRUGS. 

nilid or phenyl-acetamide. The word antifebrin is a registered name, 
and its use should be avoided by the profession, since its employment 
obliges the druggist to use the acetanilid made by one firm instead of 
the compound made by other chemists who manufacture the drug as 
an ordinary chemical compound, and do not charge so high a price as 
do those who market the registered product. 

Physiological Action. — Acetanilid has been studied experimentally 
and clinically to a very great extent, and fairly definite outlines of its 
action have been mapped out. 

Nervous System. — On the nervous system acetanilid has been 
found to act as a sedative, the sensory portion of the nerves and spinal 
cord particularly being quieted. After a poisonous dose general anaes- 
thesia comes on, with total loss of reflex action and with motor and 
sensory paralysis. The portions of the nervous system affected in 
these changes are, primarily, the sensory side of the spinal cord and 
the sensory nerves, the motor apparatus being least influenced. The 
muscles are only indirectly influenced by the poison. 

Circulation. — On the circulation acetanilid has but little direct 
influence except when used in poisonous doses. Applied to the frog's 
heart, it at first accelerates its beat and increases its force, but soon 
causes a weakening, ending with arrest in wide diastole. Upon the 
higher animals it causes, in toxic dose, an immediate fall of arterial 
pressure with a diminution in the size of the pulse-waves and all the 
evidences of cardiac and circulatory depression, notwithstanding the 
fact that death ensues from respiratory failure. The cause of this 
fall of blood-pressure is a direct depressing action on the heart asso- 
ciated with failure of the vasomotor system, as asphyxia causes no 
rise in pressure. 

In medicinal dose acetanilid causes no circulatory changes of 
moment in the healthy individual. Sometimes the pulse-rate is in- 
creased, sometimes diminished. The tendency is, however, toward 
depression rather than stimulation of the circulation. 

Blood. — When used in large doses, the action of this drug upon 
the blood is more pronounced than its influence upon any other part 
of the body, causing this tissue to become brownish-red, decreasing 
its oxygen-carrying power, and, finally, reducing the hemoglobin 
to methsemoglobin to a very considerable extent. The question as 
to the influence of acetanilid upon the corpuscles is still undecided, 
some observers declaring that these bodies are disorganized, while 
others assert that they remain intact. In moderately large poison- 
ous doses it may not affect the corpuscles, but if its use in large 
amount be continued for some days, or a very large amount be used 
at one time, corpuscular destruction certainly occurs, free haemoglobin 
appearing in the urine in its characteristic forms. The normal alka- 
linity of the blood is decreased, and the urine becomes dark and 
brownish in color, and the blood-crystals of Teichmann are found in 
it. In medicinal doses the blood shows no change except in cases 



ACETANILID, OR ANTIFEBRIN. 55 

where idiosyncrasy is present or the doses are unusually large. Under 
these circumstances the blood in the arterial system becomes more 
blue than normal. 

Respiration. — No effect is produced upon this function by 
acetanilid when given in moderate doses. When poisonous doses 
are used, the breathing at once becomes rapid and labored. Large 
doses produce death by paralysis of the respiratory centres. These 
effects are primarily due to the alterations in the blood, which so 
influence oxygenation of the tissues as to spur the respiratory centre 
to greater effort, while at the same time it is beginning to be directly 
depressed by the drug itself, so that impairment of its function is soon 
manifest. Bokai asserts that the drug paralyzes the peripheral motor 
nerves, which, if true, brings forward a third factor in the respiratory 
failure. 

Temperature. — When given in full medicinal doses, acetanilid 
lowers the normal bodily temperature or else fails to produce any 
change. In poisonous doses it produces a decrease in temperature 
depending on the amount employed, and may cause collapse and 
rigors. On a fevered temperature it acts as a powerful and fairly 
constant antipyretic, lowering the fever by decreasing heat-production 
and increasing heat-dissipation, heat-production being the function 
most affected. 1 Whether the decrease in heat-production is due 
to an action on the heat-centres in the nervous system, or upon other 
causes, is not known. Some investigators have claimed that the 
fall depends upon the partial reduction of the haemoglobin of the 
blood, whereby less oxygen is carried to the tissues and less combus- 
tion ensues. This seems doubtful in view of the fact that spectroscopic 
examination of the blood fails to show any such change from the use 
of medicinal doses. That the fall of temperature is not dependent 
on the sweat produced is proved by the fact that the temperature falls 
even if enough atropine be given to stop all perspiration. 

Kidneys, Tissue-waste, and Urine. — Much contradictory evi- 
dence exists in regard to the changes which occur in these organs and 
their excretory products under the influence of acetanilid, but most 
observers agree that the excretion of urea is increased, and it is a fact 
that the researches which have been undertaken have reached a 
similar result (Lepine, Chittenden, and Taylor). Less uncertainty 
exists as to its influence on the elimination of uric acid, which is in- 
creased rather than diminished by the drug. After excessively large 
doses the urine becomes dark from the presence of broken-down blood- 
coloring matter. 

Elimination. — The drug is eliminated by the kidneys as para- 
amido-phenol sulphate, and is entirely passed out of the body in about 
twenty-four hours. 

1 The author's reasons for holding to the opinions stated can be found in his Roylston Prize 
Essay of Harvard University, on Antipyretics. 



56 DRUGS. 

Antiseptic Action. — Acetanilid possesses distinct antiseptic powers, 
but is not capable of acting as a disinfectant. (See Therapeutics.) 

Toxic Changes from Prolonged Use. — Although it has been asserted 
that no untoward effects result from the prolonged use of acetanilid 
in large doses, there can be no doubt that this assertion is untrue. 
Under these circumstances congestion of the liver, kidneys, and spleen 
occurs, and if the dose be poisonous, clots may be found in the cardiac 
cavities. There may be also a progressive decrease in the number of 
the red blood-corpuscles. 

Poisoning. — In man this drug in toxic quantity causes the lips to 
become blue, and the face livid, cyanosed, expressionless or anxious. 
The forehead and cheeks become covered with sweat, which gradually 
extends over the rest of the body. The pulse is soft and compressible, 
but slow, and finally very weak. The respirations become slow and 
shallow. . 

The treatment of a case of poisoning by acetanilid should consist 
in supporting measures, the use of stimulants, external heat, bella- 
donna to maintain blood-pressure, strychnine to aid the respiration, 
and oxygen inhalations if they are necessary to combat cyanosis. 

Therapeutics. — The employment of acetanilid in fevers must depend 
very much upon the condition of the patient and the character of his 
disease. The mere existence of a high temperature is not, correctly 
speaking, an indication for any particular remedy. The phase of 
the disease must be recognized, and the question as to whether the 
fever which is present is harmful must be duly weighed. (See Treat- 
ment of Fever, Part IV.) 

In typhoid fever, though the drug possesses decided antipyretic 
power, it often causes great depression and collapse, and in no way 
influences favorably the duration or general course of the disease. 

For the same reasons the use of acetanilid in phthisis is inadvisable, 
for, although it greatly affects the hectic fever, it is very apt to cause 
collapse, profuse sweating, and depression. Thus the writer has 
repeatedly seen cases of phthisis in which the attempt to control the 
fever by this drug resulted in the symptoms just named; and Riese 
points out, what the author has also noted, namely, that in this dis- 
ease cyanosis is very apt to come on after the use of the drug. 

In regard to the employment of acetanilid in sthenic fevers, it at 
once becomes evident that a drug absolutely unsuited to a case of 
asthenic disease may, on the other hand, agree with a sthenic-fever 
patient very well. In consequence of this, we find that the sweating 
produced by acetanilid is not so marked or troublesome in diseases of a 
dynamic type, and that, in consequence, it more rarely causes collapse ; 
but even in this class of cases, and particularly in both varieties of 
pneumonia, the use of acetanilid is rarely advisable. Indeed the anti- 
pyretic use of this and similar compounds is yearly becoming less and 
less. 

In much the same manner that antipyrin was found, some time 



ACETANILID, OR ANTIFEBRIN. 57 

after its introduction, to be possessed of pain-relieving power, so ace- 
tanilid has been discovered to possess similar properties. Almost 
every form of nerve-pain seems to indicate its employment. It has 
been successfully used in the crises of ataxia, the agonizing dartings 
of gastralgia, in cases of sciatica, and severe headaches often yield to 
its influence. Experience has proved it to be of value in epilepsy. 

The employment of acetanilid in acute rheumatism may be separated, 
if desired, into that devoted to the cure of the disease, with the relief 
of pain, and the reduction of pyrexia. There can be no doubt what- 
ever of the ability of the drug to control the fever of this disease, and 
the question as to whether it favorably influences the severity of the 
pain of the malady is to be answered strongly in the affirmative 
(See Rheumatism, Part IV.) The dose for cases of rheumatism 
should be 4 (0.25) to 6 grains (0.4) three times a day. In subacute 
rheumatism of the muscular type acetanilid will often give marked relief. 

Acetanilid in dry powder is of value in the treatment of chancroids, 
and in the antiseptic dressing of wounds when used alone or with 
equal parts of borax. 

In many cases of obstinate vomiting, particularly that following 
surgical operations when an anaesthetic has been used, acetanilid is a 
useful remedy. The drug is usually best given in the dose of 1 grain 
(0.06) every half-hour until 6 grains (0.4) have been taken; and the 
following prescription may be used in compressed tablet, pill, or 
powder, preferably the latter, in order to increase the sedative effect 
on the stomach and steady the heart. 

1$ — Acetanilidi . . . gr. vj (0.4). 

Caffein. citrat . gr. iij (0.2). 

Camphor, monobromatae gr. vj (0.4). — M. 

Ft. in pil. vel chart. No. vi. 
S. — Wash down with a little water or else dissolve powder in a drachm of 
brandy; pour over cracked ice, and give it from a spoon. 

Acetanilid has been recommended as a local haemostatic in 
epistaxis, and has been given internally with asserted advantage in 
haemoptysis. 

Acetanilid distinctly increases the susceptibility of a patient to 
cold, and for this reason it should not be used for the relief of 
neuralgic or other pain before leaving the house in cold weather if 
it can be avoided. 

Untoward effects are not common if acetanilid be used with care. 
The writer has collected a number of cases (thirty-eight) in which 
unfavorable signs appeared after its use, but utoward action was never 
seen unless the dose given was excessive for the case which received it. 
The dose most commonly producing such symptoms was from 3 (0.2) 
to 10 grains (0.6). In only three instances of the series did death 
occur — one from heart-clot and two from excessive dosage. No deaths 
were reported from moderate amounts, although some of the cases were 
alarming. Very rarely symptoms of poisoning by acetanilid, such 



58 DRUGS. 

as are described on p. 56, follow its general use as a dusting-powder 
over wounds and other breaks in the skin. 

Administration. — Acetanilid may be given in doses varying from 
2 (0.12) to 10 grains (0.6), the last-named amount being usually ex- 
cessive. As it is virtually insoluble in water, it should always be 
administered in wine or spirit, in which it is soluble, or in capsules 
or pills. The antipyretic effect is manifested about one hour after 
the drug is taken. When neuralgias are to be treated or similar forms 
of pain are present, monobromated camphor, in the dose of \ grain 
(0.03), may be combined with acetanilid with advantage. 

The prescription given above may be used, or the Pidvis Acetanilidi 
Compositus (U. S.) composed of acetanilid, caffeine, and sodium 
bicarbonate, a new U. S. P. formula, may be used for the same 
purpose in the dose of 5 grains (0.3). 

This pill is not to be used if there is reason to believe that marked 
renal congestion or irritation is present. 

ACETATE OF POTASSIUM. 

Potassii Acetas, U. S. and B. P., is a deliquescent neutral white 
salt of saline taste, readily soluble in water. It was at one time 
largely used in the treatment of acute rheumatism in the "alkaline 
method," as when it enters the blood it is changed into an alkaline 
carbonate. It has been supplanted by the salicylates in the treat- 
ment of most cases of rheumatism. The dose should be from -g- 
to 1 ounce (16.0-30.0) a day, A combination of 10 grains (0.6) of 
the iodide of potassium and 30 grains (2.0) of the acetate is useful in 
subacute rheumatism in some instances. 

In hepatic torpor acetate of potassium is exceedingly efficacious, and 
aids in promoting the flow of bile as well as that of the urine. It has 
been used in the treatment of the so-called uric-acid diathesis, and 
quickly renders an acid urine alkaline. At one time it was sup- 
posed to purify the blood by aiding in the oxidation of effete mate- 
rial. 

The dose of potassii acetas is from 20 grains to 2 ounces (1.3-60.0), 
the latter dose being employed only when a purgative effect is desired ; 
but other drugs are more suitable for this purpose. 

ACETIC ACID. 

Acidum Aceticum, U. S. and B. P., as used in medicine, is a clear 
liquid composed of 36 per cent, of glacial acetic acid and 64 per cent, 
of water, and having a sweetish odor. It is obtained from wood by 
destructive distillation. 

Acetum, or Vinegar, is practically dilute acetic acid. 



ACONITE, OB MONKSHOOD. 59 

Therapeutics. — Acetic acid is seldom used internally. As a pow- 
erful escharotic the glacial or absolute acetic acid (Acidum Aceticum 
Glaciate, U. S. and B. P.) is used. It may be applied to warts and 
other growths, and to old sores where the granulations are profuse and 
healing is slow. The dilute acid {Acidum Aceticum Dilutum, U. S. 
and B. P.) is used as a lotion in night-sweats and to arrest epistaxis 
and other minor hemorrhages. As a lotion to be employed it should 
be diluted one-half. Vinegar, or dilute acetic acid, has been used 
internally to decrease obesity, but is a harmful and useless remedy, 
disordering digestion and reducing the patient's strength. 

Inhalation of vinegar fumes from a cloth saturated with this liquid 
sometimes will control vomiting after the use of an anaesthetic. 

In the following mixture acetic acid may be used for the removal 
of vegetations about the external genitals: 

1^ — Acid, salicylic gr. xxx (2.0). 

Acid, acetic f§j (30.0).— M. 

S. — Apply with a camel' s-hair brush. 

Only slight pain is caused by this application. 

Poisoning. — When overdoses of acetic acid are taken, the treat- 
ment consists in the use of large draughts of milk, alkaline liquids, such 
as lime-water, soap-water, etc., and the general measures suitable for 
the treatment of gastro-enteritis. (See Gastro-enteritis, Part IV.) 

Contraindications. — Nursing mothers should not take freely of 
vinegar, as it may produce a troublesome diarrhoea in the nursling. 

ACOINE. 

Acoine is a synthetic substance introduced into ophthalmic surgery 
as a local anaesthetic and antiseptic. It is used in a 1 or 2 per cent, 
solution. 

ACONITE, or MONKSHOOD. 

The aconite of the U. S. and B. P. is derived entirely from the 
tuberous root of Aconitum Napellus. At one time the leaves were 
official, but are so no longer, and for this reason the term " radix " is 
not to be employed, as it is a useless distinction. 

Aconite is indigenous in Germany, France, and Switzerland, and 
is cultivated as a garden-plant in Europe and America. The root 
resembles so strikingly that of horseradish as to be readily confused 
with that condiment, but does not emit the pungent fumes of the 
latter when it is scraped or broken. It is also to be remembered 
that aconite produces a sensation of heat in the mouth when 
chewed. The active principle upon which the therapeutical value of 
aconite would appear to depend is aconitine, but there is reasonable 
doubt whether this can be relied upon as completely as the preparations 
of the crude drug; the aconitine of commerce, moreover, varies very 
much in strength, because some of it is amorphous and impure, while 



60 



DRUGS. 



Fig. 5. 



other samples are pure and crystalline. Further than this, even the 
crystalline form is exceedingly variable in strength. In addition to 
aconitine, Dunstan asserts that there are two amorphous alkaloids 
— namely, benzaconine and aconine. Aconitine is 200 times as toxic 
as benzaconine and 2000 times as toxic as aconine. 

Physiological Action. — When aconite is placed on the tongue it 
produces a sensation of tingling and burning which extends over the 
pharyngeal surface, and into the stomach if the drug is swallowed. 
This is due to its primary irritant and secondary benumbing action on 
the sensory nerve-endings of the mucous membrane. It sometimes 
causes a sensation of constriction in the fauces. 

Nervous System. — In full medicinal dose aconite depresses the 
functional activity of the perceptive centres in the brain, the sensory 

side of the spinal cord, but chiefly de- 
presses the peripheral ends of the sen- 
sory nerves. Applied to a mucous 
membrane, it acts as a local anaes- 
thetic, but is too irritating for this use 
in the eye. On the motor portion of 
the body it exerts little influence unless 
given in poisonous doses, when it par- 
alyzes the motor tract of the spinal cord 
and the peripheral motor nerves. 

Circulatory System. — When aco- 
nite is given in moderate medicinal dose 
it exercises no marked effect on any part 
of the organism save the circulation, 
which becomes somewhat slower from 
stimulation of the vagus centres and 

A, vagus centre stimulated by aconite, h 7 the dm g ^ tin g aS a Sedative to the 
which slows pulse; B, heart-muscle de- heart-muscle itself. The arterial preSS- 
pressed which slows pulse; c, vasomotor ure j s slightly decreased by these doses, 

centre depressed, which lowers arterial -\ • n i i i • v s> 

tension; d, respiratory centre depressed, chiefly by the decrease m cardiac force. 

If large doses are used, the pulse be- 
comes still more feeble and slow, and the arterial pressure falls from 
depression of the vasomotor centre. When a poisonous dose is given, 
it causes first a marked fall in pulse-rate and arterial pressure, pre- 
ceded sometimes by a quickening due to a condition of weakness and 
abortive cardiac action: this condition gradually passes into diastolic 
arrest of the heart, the viscus becoming paralyzed and refusing to 
respond to stimuli. 

Respiration. — In moderate doses aconite quiets the respiratory 
movements slightly, particularly if the breathing is hurried. In poison- 
ous doses it paralyzes the respiratory centres, and so causes death. 

Temperature. — Aconite acts as a distinct reducer of fever, proba- 
bly because of increased heat-radiation arising from relaxation of the 
capillaries and impaired circulation. 




ACONITE, OR MONKSHOOD. 61 

Absorption and Elimination. — Aconite is rapidly absorbed and 
destroyed by oxidation, so that its effects do not last for any length of 
time. The effect of aconite when given in a large medicinal dose lasts 
for about three hours. It usually increases the urinary flow. 

Poisoning. — When aconite is taken internally in excessive amount, 
it causes tingling of the mucous membranes wherever it touches them, 
which sensation finally amounts to severe burning. This soon passes 
away, and is followed by a sense of tingling about the lips and finger- 
tips or all over the skin. At the same time the patient feels relaxed; 
the pulse at first becomes weak and slow, but later may be rapid and 
running, so that it seems a mere trickle under the finger; sweating is 
more or less marked, and fainting may ensue. Vomiting may 
occur, but is rare. The respirations now become slow and shallow, 
seeming to expand the lung to the smallest possible extent consistent 
with life. The face is pallid and anxious. Consciousness is pre- 
served unless lost through an attack of syncope. There may be 
exophthalmos, or the eyes may be sunken and dull. The sclerotic 
is pale and pearly-looking. There is excessive pallor of the face. 
Clonic convulsions of unknown origin sometimes occur. There may 
be marked anaesthesia of the skin. The pupils may be normal, con- 
tracted, or dilated widely. The temperature of the body is sub- 
normal. Death may be gradual or sudden, the slightest movement 
of the body which throws any strain on the heart stopping that 
organ in diastole. 

Treatment of Poisoning. — The patient is to be placed in a prone 
position on a bed or board, with the feet higher than the head, in order 
to confine the circulation as far as possible to the vital centres at the 
base of the brain. Hot bottles or bricks are to be placed about the 
body for the purpose of maintaining the bodily heat. Emetics are not 
to be given if the symptoms are severe, as vomiting may cause cardiac 
failure, owing to the muscular effort involved, or the stomach may be 
so depressed that emetics will not act. If vomiting comes on, the 
vomitus should be received into a towel, the patient not being allowed 
to raise his head. The stomach is to be washed out by means of a 
stomach-pump or a siphon of rubber tubing. Ether may be given hypo- 
dermically, and followed by alcohol, and this again by digitalis. The 
ether acts at once, and stimulates while the alcohol is being absorbed, 
and the alcohol supports the heart until the digitalis, which is the 
physiological antagonist of aconite, but slow and more prolonged in 
its effects, asserts itself. Atropine, because of its stimulating effect 
on the vasomotor system, may also be used. If the breathing fails, 
artificial respiration is to be employed, or if the heart seems about to 
cease its action, a whiff of nitrite of amyl may start it going again, 
but only a few drops of the nitrite should be used, as large amounts 
depress this organ. Full hypodermic doses of strychnine, such as 
A" to A (0.003-0.006) grain, may be given to stimulate the respira- 
tion and heart. 



62 DRUGS. 

Untoward Effects. — Aconite may cause in susceptible persons a 
vesicular, or even a pustular, eruption, or instead intense itching of the 
skin may be developed. 

Therapeutics. — The employment of aconite in disease is one of the 
most universally recognized procedures in medicine. It fulfils indi- 
cations which nothing else can, and lends itself to the control of a 
large number of morbid processes, its effects being uniformly explain- 
able by its known physiological action. It is used chiefly for its influ- 
ence as a cardiac and circulatory sedative, for its effects on the periph- 
eral sensory nervous system, as in the vomiting of pregnancy , and in 
those states in which, through inflammation elsewhere, the nervous 
system needs a sedative which will simultaneously reduce arterial 
tension. In the early stages of all acute inflammations aconite is of 
service. It may be applied locally over superficial nerves in neuralgia 
in the form of an ointment (2 grains [0.12] to 1 drachm [4.0], or as the 
oleate of aconitine, 2 grains [0.12] of the oleate to 100 [6.6] of sweet oil). 
In the earlier stages of gonorrhoea aconite in small doses frequently 
repeated is a most valuable remedy, and later in the disease tends to 
prevent chordee by its influence on the nervous centres. It is useful 
in croup, quinsy, sore throat, severe colds, bronchitis, and asthma due 
to exposure, in their early stages. When suppression of menstruation 
follows exposure to cold, this drug, given with a hot drink and a hot 
sitz-bath, will often restore the flow. In pericarditis it is valuable 
to allay the inflammation and quiet the excited heart, and it is also 
of marked value in the earliest stages of sthenic pneumonia if arterial 
excitement is present. Aconite is by far the best circulatory and 
nervous sedative for children suffering from sthenic fevers, particu- 
larly of the irritative type. It ought not to be used in adynamic, 
asthenic affections. Aconite is harmful in prolonged acute diseases, 
such as scarlet fever, if constantly employed. 

In persons who suffer from asthma which is preceded by coryza 
aconite does good if given in the earliest stages. 

tn nervous palpitation of the heart and in the palpitation of exces- 
sive cardiac hypertrophy aconite is valuable. In many cases of this 
character where there is not only hypertrophy, but also impaired inner- 
vation, the use of a prescription containing aconite and digitalis proves 
of service, for the minute doses of digitalis stimulate the vagus nerves, 
and the aconite not only steadies the heart by its stimulant effect on 
the vagus, but also counteracts the stimulant effect of the digitalis on 
the heart-muscle: 



R — Tinct. aconiti 

Tinct. digitalis . 

Tinct. belladonna? 

Tinct. gentian, comp. 
S. — Teaspoonful every six hours 



• f3ij(8-0). 

. fflxlv (3.0). 

. f3iss(6.0). 

q.s. ad fjiij (90.0).— M. 



In the epistaxis of full-blooded people aconite often affords great 
relief. 



AGARICIN. 63 

Full doses of Duquesnel's crystalline aconitine are of value in some 
cases of obstinate neuralgia. This crystalline salt is about 4 times 
stronger than the amorphous variety. 

Administration. — As a general rule, small divided doses of the 
drug in the form of the tincture, \ to h minim (0.015-0.030) given 
every fifteen minutes, will act better than a full dose given at once, 
unless the condition of the patient requires very active treatment. 

Preparations. — Tincture of aconite (Tinctura Aconiti, U. S. and 
B. P.) is used in the dose of 3 to 20 minims (0.20-1.30) in water, 
repeated every hour if needed. A very useful way of employing it 
is in the form of tablet triturates. The extract of aconite (Extr actum 
Aconiti) is given in the dose of \ to f grain (0.015-0.045), while of 
the abstract 1 grain (0.06) is used. The fluid extract (Fluidextractum 
Aconiti, U. S.) is given in the dose of 1 to 2 minims (0,05-0.1). 
Fleming's tincture ought never to be used. The dose of the active 
principle of aconitine (Aconitina, U. S. and B. P.) is -yj-g- to y-g-g- 
grain (0.0003-0.0006), but it ought never to be used internally. 
The B. P. preparations that are not official in the U. S. P. are : 
aconitine ointment (Unguentum Aconitince) and aconite liniment 
(Linimentum Aconiti). 

ADONIS VERNALIS. 

From Adonis vernalis, a plant indigenous in Europe and Asia, is 
derived a glucoside, Adonidin. When given to one of the mammalia 
- — the dog, for instance — it causes an increase in heart-force and a 
rise of arterial pressure. In the frog poisonous amounts arrest the 
heart in diastole. 

The indications for the use of adonidin are all conditions of cardiac 
failure, particularly the presence of cardiac dropsy. It is much infe- 
rior to digitalis and caffeine, but may be employed when these fail, as 
it sometimes succeeds under such circumstances. Within the last few 
years adonis vernalis and bromides have been combined in the treat- 
ment of epilepsy with asserted success. 

The dose of adonidin is \ to \ grain (0.008-0.015) three times 
a day; or 4 to 8 parts of the plant — all portions of which are employed 
— may be added to 180 parts of water, and of this infusion a half 
ounce (16.0) may be given every four hours. 

AGARICIN. 

Agaric, or Touchwood, or Punk, has been used in the Southern 
United States very largely in the dose of 5 grains (0.3) every few hours 
in the treatment of the night-sweats of phthisis; and agaricin, the 
alcoholic extract of the drug, has been used with extraordinary 
results, under these circumstances, by certain German and English 
physicians, in the dose of from 1 to 2 grains (0.06-0.12) every five 



64 DRUGS. 

hours. Its physiological action is unknown, but it is supposed to act 
upon the nerve-filaments in the sweat-glands. The writer has em- 
ployed it frequently in varying dose, and has never seen any decrease 
whatever produced by it in the sweats of phthisis, although he has 
watched its action most closely. Sometimes agaricin causes nausea 
and diarrhoea. 

ALCOHOL. 

Ethyl Alcohol (Alcohol Ethylicum) is the only alcohol used in medi- 
cine. Some of the other alcohols are exceedingly poisonous. Amylic 
alcohol is fusel oil. 

Alcohol is a liquid resulting from the fermentation of starches or 
sugars in the presence of heat. It is official in three forms — namely, as 
Alcohol, U. S., containing 92.3 per cent, by weight of the spirit and 7.7 
per cent, of water; Alcohol Absolutum, U. S. and B. P., containing not 
more than 1 per cent, by weight of water; and Alcohol Dilutum, U. S., 
or dilute alcohol, 41.5 per cent, by weight of spirit and the remainder 
water. The drug is generally given in the form of whiskey or brandy, 
and when the word alcohol is used in the saying, "Give the patient 
alcohol/' one of these two liquids is always meant unless it is other- 
wise stated. 

Notwithstanding the almost universal use of alcohol as a stimulant by 
the laity and the medical profession, it cannot be denied that evidence 
of scientific character and weight is constantly being brought forward 
which shows that its dominant action is depressant upon all parts of the 
body. It is claimed that under its influence the total amount of work 
accomplished in a given space of time is less than when it is not taken, 
and that the quickening of the pulse under its influence is more apparent 
than real. On the one hand, therefore, a vast mass of evidence seems 
to exist against the general employment of alcohol as a stimulant; while 
on the other clinical experience, too great to be ignored, stands for 
the continued employment of the drug. While the author is forced 
to admit that the pharmacological evidence is too strong to be denied, 
he still deliberately allows the therapeutic advice which follows to 
remain as in earlier editions, still employs alcohol as a stimulant as 
before, and fully believes that its administration is often followed by 
most beneficent results which other drugs will not produce. It is 
possible that the drug does not act as a stimulant in the ordinary sense 
of the term, but nevertheless readjusts the circulation or influences the 
protective power of the body by affecting the blood-cells or the blood- 
serum or the lymph. This belief seems to find support by reason 
of recent experiments carried out by himself, in which he was able to 
show that alcohol produces a distinct increase in the bacteriolytic 
power of the blood in disease, probably by increasing the activity of 
the complemental body. This is perhaps the explanation of the 
good results which follow the use of the drug in clinical medicine, 



ALCOHOL. 65 

Physiological Action. — Nervous System. — Alcohol never acts as a 
true stimulant to the brain, the spinal cord, or tne nerves. On the 
contrary, its dominant influence is depressant. The increased activity 
of thought and speech after its use is not due to stimulation, but to 
depression of the inhibitory nervous apparatus. The activity is there- 
fore that caused by lack of control, and is not a real increase in 
energy. So far as the brain is concerned, it does not increase the vigor 
of thought nor its depth, nor does it enable a man to work out a 
problem which is difficult. On the contrary, it rather benumbs the 
activity of mental processes. The effect of moderate doses differs 
from the effect of large ones in degree, but not in kind. Reflex 
action may be increased by the same depression of inhibition, but not 
by reason of any true stimulation of the cord. Locally applied in 
small amounts to the peripheral nerves, it excites them at first and 
paralyzes them afterward. In large doses it produces lack of co- 
ordination by depression of the brain and lower nervous system, the 
loss of co-ordination being due largely to impairment of sensation, 
so that the sense of touch and the muscle sense are interfered 
with. This effect makes a drunken man fail to recognize the angles 
or uneven surfaces of surrounding objects, and the impaired men- 
tal power and disordered judgment, combined with the imper- 
fectly acting motor and sensory pathways, cause him to stumble and 
fall. 

Circulatory System. — Careful scientific research has proved that 
alcohol is in no sense a true stimulant to the circulation. Given in 
such a dilute form that it cannot act as a local irritant to the stomach, 
it produces no change in pulse-rate or pulse-force. If the dose is large 
enough to cause any appreciable change in the circulation, it is in the 
nature of depression rather than stimulation. These results are 
obtained at the laboratory and bedside. Alcohol does, however, pro- 
duce very marked alterations in the distribution of the blood, as is seen 
in the flushing of the capillaries of the skin after its moderate use. 
Whether this altered distribution depends upon an influence exerted 
upon the vasomotor centre or nerves has not been determined. Meltzer 
thinks it is due to a stimulation of the vasodilators or to inhibition of the 
vasoconstrictors. The beneficial action following the use of alcohol 
in disease when it is thought to act as a stimulant probably depends 
upon the improved distribution of blood it produces, just as the use of 
the sponge bath or cold plunge in typhoid fever readjusts the circula- 
tion and restores vascular tone. Little if any effect is exercised 
by alcohol upon arterial pressure when given in medicinal dose. In 
very large toxic doses alcohol depresses and finally paralyzes the heart 
and vasomotor system. 

Respiration. — Respiration is not materially affected by alcohol. 

Temperature. — Alcohol never increases the number of heat units 
in the body, for though in its oxidation more heat is made than when 
no alcohol is used, the increased radiation, or loss of heat, from the 

5 



qq DRUGS. 

skin and lungs under its influence more than counterbalances the gain 
caused by the drug. 

By its irritating effect on the mucous membrane of the mouth 
and stomach it produces a sensation of warmth, and warms the ex- 
tremities at the expense of the body by increasing the circulation 
of blood in those parts. This increase in the peripheral circulation is 
due to an increase in the rapidity of the flow of blood and to dilatation 
of the peripheral capillaries. If it be used to excess, the temperature 
rapidly falls, owing to the increase of heat-radiation produced by the 
free distribution of blood, as has just been described, and secondarily 
by the depression of the vital forces, for in overdose alcohol always 
acts as a depressant. 

Bodily Metabolism. — The quantity of carbonic acid given off by 
the body under the use of alcohol is not materially altered. Some 
observers have noted an increase, some a decrease, and some no change 
at all when alcohol is taken. These results have probably depended 
upon the work required at the time the alcohol is in the body, for the 
influences of exercise and rest are potent factors in determining the 
activity of combustion or oxidation processes in the economy. Alcohol 
always conserves the body-fat and in all probability the body proteids 
as well. That is to say, alcohol, by being burned up in the body, 
yields energy and so saves tissues which would otherwise be oxidized 
if no alcohol were taken. To express it in still another way: alcohol, 
by its oxidation,, adds force, but not tissue, to the body. 

Elimination. — Alcohol is rapidly absorbed and rapidly destroyed 
by or eliminated from the body. In medicinal doses it is largely " burnt 
up"; but when taken in excess of the body's oxidizing power it is 
eliminated by the lungs and by the skin, kidneys, and intestines. 

Digestion. — Alcohol added in any amount to food in a test-tube 
containing digestive ferments retards or inhibits digestion, but in the 
stomach, on the other hand, when used in moderation, it assists the 
process; for by reason of its irritant and stimulating properties it 
induces the secretion of an excess of the digestive juice. When exces- 
sive amounts are ingested it disorders digestion by inhibiting the action 
of the digestive ferments. 

Therapeutics. — The chief uses of alcohol are as a rapidly-acting 
stimulant in all forms of cardiac failure due to shock or to poisons, 
and as a systemic support and stimulant in low fevers and prolonged 
wasting diseases, in old age, and in convalescence from acute disease. 
In both croupous and catarrhal pneumonia alcohol is useful, and par- 
ticularly is this true when these affections occur in children. (See 
Pneumonia, Part IV.) 

Some additional conditions, to state them specifically, in which 
alcohol is indicated are fainting, snake-bite, surgical shock, chronic 
'pneumonia in its later stages, and excessive wasting due to prolonged 
suppuration. 

Alcohol should never be given in the presence of circulatory excite- 



ALCOHOL. 67 

ment, but whenever the circulation fails during the progress of an 
acute disease it is useful. In the pneumonia of children, whether it 
be croupous or catarrhal, brandy or whiskey is very useful in the dose 
of 5 to 60 minims (0.3-4.0) every two hours in a little water or milk 
when the circulation seems feeble. (See Administration.) In exhaust- 
ing fevers, such as typhoid or typhus, alcohol finds its true usefulness. 
While it is well to give alcohol in some cases of enteric fever from the 
beginning to the end of the attack, for the double purpose of aiding 
digestion and of supporting the system, its administration should not 
be a mere matter of routine, but should be based upon clear ideas of 
the indications it is calculated to fulfil. If the pulse is weak and the 
patient seems to be sinking, or the appetite is failing and adynamia 
is a pressing symptom, alcohol is indicated; but if the pulse is good, 
and the passage of the patient through his illness is not a stormy one, 
alcohol should be excluded from the sick-room. Sometimes ordinary 
whiskey or brandy will in severe typhoid fever disorder the stomach. 
The physician should then employ an old brandy or wine which has 
acquired by age an aroma which is called a "bouquet." 

In persistent vomiting the use of small doses of good brandy poured 
on cracked ice will often do much good. 

Alcohol is not only of service internally, but it is also useful exter- 
nally as a wash or evaporating lotion over bruises, inflamed joints, 
and wounds of a contused character. It acts as a cooling and anti- 
septic dressing. When used for its influence as a local antiseptic it 
acts best in the strength of 60 to 70 per cent, by volume, as the presence 
of the 30 or 40 per cent, of water, by softening the bacterial envelope, 
enables the alcohol to destroy the germ. Absolute alcohol is there- 
fore much less serviceable than the dilute form. Alcohol is also useful 
for washing the skin of invalids, and "salt and whiskey" applied by 
rubbing is an excellent mixture to stimulate the skin of unhealthy 
persons. 

Acute Poisoning. — In advanced poisoning by alcohol, with coma 
and total relaxation, external heat and hypodermic injections of digi- 
talis and strychnine are indicated if the heart or respiration seems to 
be failing. Belladonna should be administered to stimulate the vaso- 
motor system if the skin is relaxed and clammy, and counterirritation 
to the back of the neck is to be employed if any brain symptoms are 
present. The after-treatment consists in the use of substances stimu- 
lating to the stomach, such as ammonia, spirit of Mindererus, and 
spices, unless there is gastric inflammation, when emollient substances 
should be used to quiet the irritation. If persistent vomiting comes 
on, it must be quieted by the patient swallowing pieces of ice, by 
cocaine,, or minute doses of ipecac. Counterirritation should be 
applied over the belly. If the emunctories are not acting freely, thor- 
ough purgation by jalap or elaterium (40 grains [2.6] of jalap powder 
or J grain [0.008] of elaterium) should be employed; or full doses 
of calomel followed by a saline may be given if milder effects are 



68 DRUGS. 

sought. For the morning vomiting of drunkards Fowler's solution of 
arsenic is often a valuable remedy. 

In view of the frequency with which alcoholic and opium poisoning 
are confused, the following table is appended, which will be found of 
value in making a differential 'diagnosis as to the condition of the 
patient: 

Alcoholism and Opium Poisoning, 

Alcoholism. Opium Poisoning. 

1. Pupils normal or dilated 1. Pupils contracted. 

2. Respiration nearly normal. Pulse 2. Respiration and pulse slow and 
rapid, and finally feeble. full. 

3. Face may be pallid. 3. Face suffused and cyanosed. 

4. Skin cool, perhaps moist. 4. Skin warmer than in alcoholic 

poisoning. 

5. Pulse rapid, at first strong, then 5. Pulse slow, strong, and full till 
weak. late in poisoning. 

There is scarcely any difference as to consciousness in the two conditions. 
In medico-legal cases the urine should be preserved in hermetically sealed vessels 
for examination. 

Acute alcoholism and apoplexy are often confused. They are 
differentiated in the following table: 

Acute Alcoholism and Apoplexy. 

Alcoholism. Apoplexy. 

1 . Pulse rapid, compressible, and weak. 1 . Pulse apt to be strong and slow. 

2. Skin moist, or relaxed and cool. 2. Skin hot or dry. 

3. Bodily temperature lowered. 3. Bodily temperature raised. 

4. Pupils equally contracted or dilated; 4. Pupils unequal, 
generally dilated. 

5. No hemiplegia. 5. Hemiplegia: one side moved, the 

other remaining motionless. 

6. Breathing not so stertorous nor so 6. Respiration stertorous, the lips 
one-sided in lips. being inflated on one side on expiration. 

7. No facial palsy. 7. Facial palsy. 

8. Unconsciousness may not be com- 8. Unconsciousness complete, 
plete. 

. The odor of alcohol in the breath is no guide, as acute alcoholism may have 
caused the rupture of a cerebral bloodvessel. 

Chronic Poisoning or the Alcoholic Habit. — Chronic poisoning by 
alcohol results in very characteristic changes in the tissues. As the 
liver receives the alcohol from the stomach diluted only by the portal 
blood, it is often affected very early, and cirrhosis of this organ comes 
on with its accompanying gastric and nutritional symptoms. Mental 
disturbances are common, and neuritis may develop and produce 
paralysis or symptoms resembling locomotor ataxia. 1 

The treatment of chronic alcoholic poisoning may be carried out in 
two ways : First, by the isolation of the patient and the complete with- 
drawal of the drug at once ; secondly, by a better plan, a gradual taper- 
ing-off in the daily amount of the spirit. In either instance isolation 
must be absolute, and all smuggling of alcohol to or by the patient 

1 See author's work on Diagnosis, Lea Brothers & Co., Philadelphia. 



ALCOHOL. (jo 

prevented. The attendants must be absolutely trustworthy. Care- 
ful scrutiny of bed-clothes and closets will often be rewarded by finding 
hidden whiskey-bottles. The depression of the patient when recov- 
ering from alcoholism must be met by the use of nutritious broths, 
highly seasoned in order to stimulate the stomach, by easily digested 
or predigested foods, and by small doses of morphine or coca if the 
patient be very weak and need such a stimulus. Koumyss is an 
exceedingly valuable and nutritious preparation under these circum- 
stances. 

In the treatment of the atonic stomach of drunkards a valuable aid 
is to be found in the following pill : 

1^ — Oleoresin. capsici rrix (0.60). 

Olei caryophylli TTlx (0.60). 

Hvdrarg. chlor. mit gr. xx (1.3). 

Aloe -..".. gr. xl (2.6).— M. 

Ft. in pil. No. xx. 

S. — One three times a day after or before meals. 

If this pill fails to move the bowels, a saline purgative should be 
used. 

The following are the principal points in the differential diagnosis of 

Chronic Alcoholism and the General Paralysis of the Insane. 

Chronic Alcoholism. Paretic Dementia. 

1. Attacks shorter, and more widely 1. Attacks more prolonged, 
separated by intervals of sanity. 

2. Delirium may be of any character. 2. Delirium of grandeur more marked 

and defined. 

3. Visions more characteristic, and are 3. Visions often not evil, but pleas- 
evil, ant. 

4. Tremors confined to head and arms. 4. Tremors more diffused 

5. Tremors removed by dose of alcohol. 5. Tremors made worse by alcohol. 

6. Mental symptoms temporarily re- 6. Mental state made worse by al- 
moved, or at any rate improved, by al- cohol. 

cohol. 

7. Tremors occur chiefly in the morn- 7. Tremors not confined to the morn- 
ing, ing. 

There is danger of pneumonia from failure of the right side of the 
heart in subacute and chronic alcoholism, and the physician should 
ahvays be on the lookout for this complication. 

Aministration. — Brandy and whiskey are generally used as rapidly- 
acting stimulants. They should be exhibited in the form best adapted 
to the work they are intended to perform. If the action must be 
instantaneous, as in a case of fainting, they should be employed hot 
and concentrated, so that the stomach has not to warm the liquid 
before absorption. They are to be used hypodermically if still more 
rapid action is required. If administered to aid digestion and support 
the system, then they should always be given with the food — never 
alone, and never concentrated. They may be given as milk-punch or 
as eggnog, the latter being the "heavier" of the two so far as diges- 



70 DRUGS. 

tion is concerned. In fevers of a typhoid type the dose of whiskey o^* 
brandy should be for an adult from J to 2 ounces (15.0-60.0) ever? 
three or four hours. More than a pint in twenty-four hours is rarely 
required, but this amount often does great good and is not excessive 
if the patient is accustomed to its use and need stimulation. When 
brandy or whiskey is given to children, the following rules as to dosage 
may be used as indicating the approximate proper dose : 5 to 10 minims 
(0.30-0.60) every four hours for a child one month old; 10 to 20 
minims (0.60-1.30) for a child two months old; 20 to 30 minims (1.3- 
2.0) for a child three months old; 30 to 40 minims (2.0-2.6) for a 
child over three months old; 60 minims (4.0) for a child over four 
months old. In some cases, however, it is well to use half these doses 
every two hours. In all cases the liquor should be diluted with hot. 
or cool water. Wine-whey is very light and useful. Mulled wine 
and champagne are particularly useful in the treatment of irritable 
stomach. (See Foods for the Sick.) Champagne when used as a 
medicinal stimulant should always be as devoid of sugar as possible — 
that is, what is known as "extra dry" or "Brut." Gin is rarely 
employed as a stimulant, except when the kidneys are torpid. Stout 
and porter are of value in wasting diseases, in convalescence from 
acute diseases, and for nursing women. 

Contraindications. — All states of cerebral excitement, unless due 
to exhaustion, acute inflammations, the alcoholic habit, apoplexy, 
meningitis, acute nephritis, aneurism, and advanced atheroma, con- 
traindicate the use of alcohol, as does also the history of the alcoholic 
habit. 

The official preparations of alcohol are as follows: 

Whiskey (Spiritus Frumenti, U. S.) should be at least four years 
old, and be made, in America, from rye, for medicinal purposes./ 

Brandy (Spiritus Vini Gallici, U. S. and B. P.) is obtained by the 
distillation of fermented grapes or fruits, and should be from three to 
five years old before use. 

Cologne-water (Spiritus Odoratus) is used solely as a lotion and 
perfume. 

Red wine (Vinum Rubrum, U. S.) is made from grapes not deprived 
of their skins. White Wine (Vinum Album, U. S.) is the fermented 
juice of grapes the skins of which have been removed. 

Dilute Alcohol (Alcohol Dilutum, U. S.), pure alcohol (Alcohol, 
U. S.), and absolute alcohol (Alcohol Absolutum, U. S. and B. P.) are 
also official. 

The unofficial preparations are: 

Rum, which is made from the fermentation of molasses, and con- 
tains about 40 to 45 per cent, of alcohol. 

Gin is made from rye or barley, with the addition of juniper-berries 
and hops. (Good "dry" gin and the Spiritus Juniperi Compositus of 
the U. S. P. are virtually identical therapeutically.) W r hen diuresis is 
required and atony of the kidneys is present, without inflammation, gin 



/ 



ALLSPICE. 71 

is a useful medicament, provided that a stimulant is indicated. Gin 
is one of the alcoholic drinks most apt to produce cirrhosis of the 
liver. 

Port Wine (Vinum Portense) is a fermented wine, to which pure 
spirit is added to increase its strength. It is one of the strongest table 
wines, and is useful as a stimulant in convalescence. 

Sherry (Vinum Xericum) has about 30 per cent, of alcohol in it. 
It is not official in the U. S. P. 

Beer is made by a slow fermentation, while ale is made by a more 
rapid fermentation at a higher heat. Most of the beer in America 
contains about 4-6 per cent, of alcohol. 

Porter resembles the other malt liquors closely, except that it con- 
tains more solids, due to a scorching of the grain by a high heat. 

The B. P. preparations that are not official in the U. S. P. are 
rectified spirit (Spiritus Rectificatus) , sherry (Vinum Xericum), and 
Mistura Spiritus Vini Gallici, which is a useful, pleasant, and nutri- 
tious stimulant made by beating up the yolks of two eggs with half 
an ounce of sugar, and then adding four ounces each of brandy and 
cinnamon-water. This is sometimes called "egg-flip." 

ALLIUM. 

Garlic, or Allium Sativum, is a stimulant to digestion, owing to 
the volatile oil it contains, which by its somewhat irritating proper- 
ties excites the gastric mucous membrane to increased secretion. In 
persistent colds, where the bronchial tubes are particularly affected, a 
garlic poultice made by pounding the bulbs in a mortar, is a very 
efficient though disagreeable remedy. If the skin is too delicate to 
permit of the use of pounded garlic alone, it may be mixed with equal 
parts of bran, and a poultice or plaster made thereof. Employed 
in this form, allium is useful if applied over the spine or feet in the 
treatment of the cerebral and spinal convulsions of infants; placed 
over the belly in cases of g astro-intestinal catarrh, it acts almost as 
well as a spice poultice. In the treatment of children with chronic 
colds garlic may be used boiled in milk, and the liquid given as a 
drink, warm or cold; or the oil of garlic may be given in emulsion 
in the dose of 1 or 2 minims (0.05-0.10). It ought not to be given 
during the febrile stage, as it is stimulating. Allium-juice has also 
been used in the dose of 2 to 5 drops (0.1-0.3), to relieve nervous 
vomiting. The dose of the syrup (Syrupus Allii) for a child is 1 
drachm (4.0), but 4 drachms (16.0) may be given to an adult. 

ALLSPICE. 

Allspice, or Pimenta (U. S. and B. P.), is the nearly ripe fruit of 
Pimenta officinalis, a tree of the West Indies. It contains an official 
volatile oil (Oleum Pimento 3 , U. S. and B. P.), used for flavoring pur- 



72 DRUGS. 

poses, as a constituent of spice plasters, in diarrhoea mixtures, or as a 
carminative. It will also prevent the griping of purgative medicines. 
The dose of the oil is 1 to 5 minims (0.05-0.30). Aqua Pimentoe (B. P.) 
is given in the dose of 1 to 2 ounces (30.0-60.0). 



ALMONDS. 

Almonds are official in the form of the bitter almond {Amygdala 
Amara, U. S. and B. P.) and the sweet almond (Amygdala Dulcis, 
U. S. and B. P.). Bitter almonds develop hydrocyanic acid in the 
presence of water, by the reaction between the amygdalin and water 
in the presence of the emulsin contained in them; this is not the case 
with sweet almonds. 

Sweet almonds, when rubbed up in a mortar with water, form a 
pleasant-tasting emulsion of an agreeable odor that is very useful as a 
vehicle for remedies having a disagreeable taste. Almond bread has 
been proposed as a food for diabetics, owing to its containing virtually 
no starch; but it is requisite that the oils and saccharine constituents 
of the almond shall first be removed. (See Foods for the Sick.) 

When half an ounce of sweet almonds are rubbed up with thirty 
grains of gum arabic and two drachms of sugar, to which is added 
gradually a half-pint of distilled water, the mixture being then strained, 
an emollient and soothing drink is formed, which is very useful in 
irritations of the stomach and intestines and of the air-passages and 
pharynx. The expressed or fixed oil of almonds is a useful demul- 
cent, and has been recommended in the cough of phthisis, given in the 
dose of a \ drachm (2.0) in emulsion. 

Bitter almonds yield an oil (Oleum Amygdala? Amara?, U. S.) which 
is exceedingly poisonous owing to the prussic acid which it contains, 
and it is said that one drop will kill a cat, while seventeen drops have 
killed a man. Oil of bitter almond should contain from 2 to 4 per 
cent, of hydrocyanic acid. 

Bitter almonds are used to allay irritable coughs and similar states, 
but are not frequently employed because other drugs are less danger- 
ous, more stable, and more active as remedial agents. The emulsion 
of bitter almonds is made as is that of sweet almonds, and may be used 
in teaspoonful doses for the same purposes and as a vehicle in cough 
mixtures. Both emulsions are useful as vehicles in the treatment 
of gonorrhoea, as they diminish the burning on urination. Almond 
emulsions, when locally applied, are supposed to be of value for the 
removal of freckles and sunburn. 

The preparations of sweet almonds are: an emulsion (Emulsum 
Amygdala?, U. S., and Mistura Amygdala, B. P.), dose 1 to 2 ounces 
(30.0-60.0); a syrup (Syrupus Amygdala, U. S.), dose 2 drachms to 
2 ounces (8.0-60.0) ; a compound powder (Pulvis Amygdala? Composi- 
tus, B. P.), given in the dose of 1 to 2 drachms (4.0-8.0); and the oil 
(Oleum Amygdala? Expressum, U. S., and Oleum Amygdala, B. P.), 



ALOES. 73 

the dose of which is 1 to 4 drachms (4.0-16.0). Aquce Amygdalae 
AmaroB (U. S.) is prepared from the oil of bitter almonds. The dose 
is 30 to 60 minims (2.0-4.0). 

ALOES. 

Aloes, or Aloe of the U. S. P., is derived from Aloe Perryi, or Aloe 
vera. Both Socotrine and Barbadoes are official under Aloe in 
the U. S. P. of 1900. Aloes is the inspissated or dried juice of the 
leaves of the plant. It is also probably derived from several other 
species than those just named. Aloes contains an active principle 
known as aloin (Aloinum, U. S. and B. P.), which is a crystalline 
substance. As generally sold aloin is, however, an amorphous powder 
of extremely bitter taste. 

Physiological Action. — Locally applied to the tongue, aloes is a 
bitter of rather a persistent taste. According to the studies of Ruther- 
ford, the drug increases very considerably the flow of bile in the dog, 
but in man it cannot in any sense be regarded as a medicament for the 
production of an increased biliary flow. Rutherford's doses given to 
the dog amounted to as much as sixty grains, equal to three or four 
drachms in a man. In the lower animals and in man aloes acts very 
slowly, requiring many hours for its influence to be manifested unless 
the dose be toxic in amount. Its chief influence is on the lower 
bowel (Fig. 6). As much as four drachms of aloes have been injected 
into the veins of a horse without inducing purgation, probably because 
four drachms were not enough to affect the bowels. Aloes has been 
used endermically, and when so employed is said to act thoroughly. 
It is eliminated in the milk of nursing women, and will cause purga- 
tion in an infant put to the breast of a patient taking it. If the doses 
be quite large (10 to 20 grains), the passages will be watery; but if the 
dose be more moderate (2 or 3 grains), the stools will be thick and 
pultaceous. 

Therapeutics. — Aloes should be used only when a somewhat slow 
stimulant to peristaltic movement is desired, and never where the 
object of the physician is to relieve congestions by depletion through 
the intestine. It is a favorite remedy in cases of subacute or chronic 
constipation, but it is distinctly harmful if continued for any length 
of time, as it seems to produce atony of the bowel. Owing to its bit- 
ter properties it acts as a tonic to the stomach, and is often given with 
iron, as clinical experience indicates that their conjoint use is bene- 
ficial. Its good effects depend upon its preventing any constipation 
which might be produced by the chalybeate. 

When taken in a sufficiently large dose to produce a copious pas- 
sage, aloes nearly always produces a feeling of weight and fulness 
in the region of the rectum after the evacuation, and the writer has 
seen severe rectal catarrh produced in this way in very susceptible 
persons. If given alone, it is very apt to produce griping, and it 



74 



DRUGS. 



ought always to be combined with other drugs whose tendency is to 
prevent intestinal spasm. 

In cases of hemorrhoids in individuals suffering from general 
muscular relaxation and atony, aloes is said to do great good, but its 
use under these circumstances is by no means universal or generally 
accepted as correct. For weak, anaemic persons leading sedentary 
lives it may be combined with tonics to relieve the constipation so 
often an urgent symptom in these cases. In amenorrhoea dependent 
upon atony of the sexual system, or amemia, or constipation, it is 
thought to have a specific emmenagogue influence. Locally applied 
in the form of the glycerole of aloes, it has been employed in the healing 
of old or recent fissures of the rectal mucous membrane, and even in 
bed-sores. The glycerole of aloes is to be made by evaporating four 
to eight parts of tincture of aloes and gradually adding thirty parts 
of glycerin. 

8 J Fig. 6. 




A, chief effect of aloes is exercised on lower bowel or colon. 

Contraindications. — Constipation occurring in plethoric persons 
should not be treated by aloes, and it should not be used if any irrita- 
tion or catarrh of the intestine is present. Pregnant women should use 
aloes most carefully lest abortion be produced, and if hepatic conges- 
tion or inflammation is present it ought not to be used. Fever is also 
said to contraindicate the use of aloes, as does also rectal catarrh. 

Administration. — Aloes is generally given in a pill, combined with 
spices and belladonna. (See Constipation, Part IV.) The dose should 
be 1 to 5 grains (0.06-0.3) as a laxative, and 10 grains (0.6) as 
a purge. The Aloe Purificata, U. S. P., should always be used. The 
official preparations most commonly employed are the pill of aloes 
(Pilulce Aloes, U. S. and B. P.), 2 grains (0.12) each of aloes and 
soap; the pill of aloes and myrrh (Pilula? Aloes et Myrrha, U. S. 
and B. P.), 2 grains (0.12) of each constituent; the pill of aloes and 



ALUM. 75 

mastich (Pilules Aloes et Mastiches, U. S.), 2 grains (0.12) of aloes, or 
the " Lady Webster dinner pill"; the pill of aloes and iron (Pilules 
Aloes et Ferri, U. S. and B. P.), 1 grain (0.06) of aloes and 1 grain 
(0.06) of dried sulphate of iron. The dose of all these is one or two 
pills. Aloes is also official as Extractum Aloes, dose 1 to 2 grains 
(0.06-0.12). Aloin is an ingredient of the Piluloe Laxatives Compositor, 
U. S., which also contain extract of belladonna, strychnine, and 
ipecac. The liquid preparations are the tincture (Tinctura Aloes, 
U. S. and B. P.), dose 1 to 2 fluidrachms (4.0-8.0); the tincture of 
aloes and myrrh (Tinctura Aloes et Myrrhw, U. S.), 1 dose 1 to 2 
fluidrachms (4.0-8.0). The B. P. preparations, besides those given, 
are the Decoctum Aloes Compositum, dose J to 2 ounces (15.0-60.0), 
and the Extractum Aloes Barbadensis, the dose of which is 2 to 6 
grains (0.1-0.40). 

ALUM. 

Alum (Alumen, U. S. and B. P.) is the sulphate of aluminum and 
potassium in the U. S. P., but in the B. P. both it and the sulphate 
of aluminum and ammonium crystallized from a watery solution are 
official. At present much of the alum of commerce is obtained as a 
by-product in the manufacture of coal-gas for illuminating purposes, 
and it is therefore very cheap. It occurs in the form of octahedral 
crystals, and has an astringent taste and acid reaction. After the 
crystals are exposed to the air for some time they become covered 
with a white coating. 

Physiological Action. — When alum is brought in contact with a 
mucous membrane it produces whitening, constriction, and puckering 
of the part, and applied to the skin thickens and hardens it by means 
of its astringent action. In either case it decreases secretion and causes 
contraction of the local bloodvessels and capillaries. Large amounts 
given internally for any length of time seem to increase secretion. 

Poisoning. — Very large amounts are necessary to produce death. 
As much as two ounces will not kill a sickly dog. This is largely due 
to the fact that the vomiting and purging rid the animal of the drug, 
for if vomiting is prevented death rapidly ensues from gastro-enteritis. 
Injected into the blood, alum produces embolism and thrombosis. 

Therapeutics. — Alum is used at present in a number of diseases, 
chiefly as a local application. In cases of ordinary sore throat 
applications of a strong solution (20 grains to the ounce of water — 
1.3-30.0) on a swab are very useful. It would be of much service in 
this condition were it not that it possesses a destructive action on the 
teeth. In hemorrhage, when the leaking bloodvessels can be directly 
reached, alum is a powerful haemostatic, aiding in the arrest of the 
bleeding in three ways — namely, by coagulating the albumin, by con- 
stringing the parts, and by crystallizing when applied in large amounts 

1 Sometimes called Elixir Proprietatis. 



76 DRUGS. 

on lint, and thereby affording a surface which is rough and aids coagu- 
lation. In hemorrhage after tooth-extraction its application is a very 
useful treatment. Dissolved in water or alcohol, 2 grains to the ounce 
(0.1-30.0), it makes an exceedingly efficient application for sponging 
in night-sweats or localized sweating of the feet or hands. In haemop- 
tysis a fine spray of a strong solution of alum, 20 grains to the ounce 
(1.3-30.0), may be employed, the necessity of the spray being made 
very fine being constantly borne in mind. This method may also be 
resorted to in bronchorrh&a or chronic bronchitis with excessive secre- 
tion, and in chronic catarrh of the pharynx and larynx. In mercurial 
ptyalism the drug may be used on a swab. Bathing with an alum 
solution the parts affected is said to be an efficient remedy in chilblains, 
and for pruritus vulvae. As a vaginal wash for profuse leucorrhaa, 
in the strength of from 10 to 20 grains to the ounce (0.65-1.3 to 30.0) 
of water, alum is of value. Some observers claim good results from its 
use in diphtheria and tonsillitis. In follicular tonsillitis the alum-stick 
may be deeply inserted into the depressed follicles or applied to the 
swollen surface of the gland. In ingrowing toe-nail with granulations 
a piece of twisted absorbent cotton soaked in strong alum solution and 
inserted under the edge of the nail will in most instances produce a 
cure. Dried alum (Alumen Exsiccatum, U. S. and B. P.) is useful as 
a dressing for old ulcers and sores, and has been highly recommended 
as an application for swollen gums where they press upon and over- 
ride a tooth, particularly at the back of the jaw. The possibility of 
its exercising an evil effect on the teeth should not be forgotten when 
this treatment is resorted to. 

Internally, alum has been used in diabetes, gastralgia, and dysen- 
tery of an acute and chronic type. In conjunction with morphine it 
seems to be of value to allay the pain in lead colic. At one time alum 
was largely employed in membranous croup in emetic dose for the dis- 
lodging of the membrane and for the astringent effect exercised as it 
was swallowed and expelled. 

Alum may be used as an antidote in acute lead poisoning, as it is a 
soluble sulphate and also an emetic. 

The emetic dose of powdered alum is a heaping teaspoonful for a 
child or a tablespoonful for an adult. 

Glycerinum Aluminis (1 to 5) is official in the B. P., and is used as 
a local astringent application. 

AMBER. 

Succinum is derived from a fossil resin found in Prussia and in 
Bohemia, and is used in the form of the oil (Oleum Succini), which is 
volatile, quite irritant, and obtained by destructive distillation from 
the deposits named. 

Therapeutics. — Oil of Amber is one of the best remedies for per- 
sistent hiccough that we have. It is very useful as a counterirritant 



AMMONIA. 77 

over rheumatic joints, and has been used in asthma, whooping-cough, 
and hysteria with good results. In the bronchitis of infants, with 
nervous disturbance, oil of amber in the proportion of 1 to 3 parts 
of olive oil applied to the back and front of the chest is of service. In 
adults suffering from acute laryngitis with extension of the inflam- 
mation into the bronchial tubes, full doses of sodium bromide given 
internally, with this proportion of amber oil and olive oil rubbed into 
the neck and chest, are useful. The dose internally is 2 to 6 minims 
(0.1-0.4) given in emulsion. 

AMMONIA (NH 3 ). 

Ammonia is a gas of a very acrid, burning taste, capable of 
producing death very rapidly when inhaled, by reason of the inflam- 
mation of the air-passages and the spasm of the glottis which ensue. 
It is made in large amounts in the manufacture of coal-gas. 

Physiological Action. — When ammonia comes in contact with the 
tissues of the body it acts as a most powerful irritant, causing a red- 
dening of the parts, followed, if the exposure be sufficiently prolonged, 
by local death and sloughing. If it be inhaled as a gas, it may pro- 
duce rapid death by spasm or oedema of the glottis, and if a strong 
solution of it is swallowed, the same accident may occur. Following 
more moderate inhalations severe bronchitis or pulmonary oedema 
may develop. 

Nervous System. — If ammonia be injected into the blood of 
animals, violent convulsions at once ensue which are largely tetanic 
in type and depend upon a spinal action of the drug, since they are 
not stopped by division of the spinal cord, as they would be if the con- 
vulsive movements had their origin in the brain. The drug in moderate 
amounts acts as a spinal excitant, increasing reflex action and all the 
evidences of spinal activity. If applied directly to a nerve, either 
motor or sensory, it paralyzes the nerve ; but if the drug be in a very 
weak solution, seems to increase the functional activity of the nerve. 

Circulation. — Upon the circulation ammonia acts as a powerful 
but fleeting stimulant, increasing the pulse-rate, pulse-force, and 
arterial pressure. The cause of the increased pulse-rate depends upon 
stimulation of the accelerator nerves of the heart and of the heart itself, 
while the increase in force is due to the same cause, for Ringer and 
Sainsbury found the strength of the ventricles much increased. The 
rise of arterial pressure is due to the increased amount of blood pumped 
into the arteries by the stimulated heart, and probably by a stimulant 
action on the vasomotor centre, although this is denied by some 
authorities. As the drug acts as a stimulant on the respiratory 
centre, which is very near the vasomotor centre, it probably increases 
the functional activity of both. If by means of intravenous injection 
the ammonia reaches the heart in large amount in concentrated form, 
this organ ceases to beat at once, owing to paralysis of its muscular walls. 



78 



DRUGS. 



The Blood. — In moderate amounts the drug has no effect on the 
blood, but when injected in poisonous quantities it causes the blood to 
fail to take up the oxygen, according to Feltz and Ritter. 

Respiration. — The injection of ammonia in moderate quantities 
into the blood causes an acceleration of the rate of respiration due to 
a stimulation of the respiratory centre, the respiratory movements 
becoming not only more full, but also more rapid. If the drug is 
inhaled in small amounts or swallowed, the same action is seen in a less 
degree, the changes both in breathing and circulation being partly due 

under such circumstances to a reflex 
irritation transmitted along the sen- 
sory nerves. 

Elimination. — Ammonia when 
taken into the body is so extremely 
fleeting in its action that the question 
as to its escape from the system is of 
interest. If large amounts are taken, 
it is partly given off by the breath, but 
more of it is burnt up in the system, 
and, according to Bence Jones, elimi- 
nated as nitric acid by reason of its 
being oxidized in the body. Some 
think that it is in part excreted as urea. 
Therapeutics. — Ammonia is employed 
for four distinct purposes in medicine — 
namely, as a circulatory and a respi- 
ratory stimulant, as a counterirritant, 
and as an antacid. 

The indications for the use of am- 
monia in the first class of cases are 
all forms of sudden cardiac failure 
where there is no time or oppor- 
tunity to use the more stable and slowly-acting drugs. These emer- 
gencies occur in snake poisoning, in syncope from fright or other shock 
or indigestion, in sudden cardiac failure during the course of fevers 
and in pneumonia, and in all cases where rapid cardiac stimulation 
is needed. It is claimed, without much justification, that ammonia 
will aid in preventing heart-clot or thrombosis in cases of severe hemor- 
rhage and in pneumonia. In the most pressing cases it should be 
injected directly into a vein of the leg, so as to act more quickly. 
If put into the subcutaneous tissues, it is almost certain to cause a 
slough, and if injected into a vein of the arm, it may reach the heart 
in too concentrated form and cause cardiac depression. Ringer has 
found that the drug has the extraordinary power of causing a heart 
stopped or depressed by chloroform to resume its beating. 

In prolonged diseases the employment of ammonia is not particu- 
larly advisable, owing to its fugacious action, although it is largely 




Ammonia stimulates: A, the accelerator 
nerves; B, the heart-muscle itself, and so 
quickens pulse-rate and force. It stimu- 
lates the vasomotor centre C, and the 
respiratory centre D. 



AMMONIAC. 79 

used, for the frequent administration necessarily required is apt to 
produce gastric disorder. Some writers claim that ammonia is useful 
as a sedative in drunkenness, but this is doubtful. 

In gastric acidity due to fermentation, with the development of 
abnormal acids, ammonia is the most active remedy we can employ, 
but it is not to be given if acute irritation of the stomach exists. 

Locally applied, strong ammonia-water may be used to produce a 
blister by placing a few drops on the skin under an inverted watch- 
glass. Ammonia-water may also be applied, often with great relief, 
to the spot stung by insects. The waters of ammonia are used exter- 
nally in stimulating liniments, and hypodermically when the drug is 
so given. The stronger water ought not to be employed for the latter 
purpose. The aromatic spirit is generally used internally in the dose 
of \ drachm to 1 drachm (2.0-4.0), well diluted. This is also the 
dose of the ordinary spirit. 

Administration. — Ammonia is never employed in medicine as pure 
ammonia gas, but in the form of the stronger water (Aqua Ammonia? 
Fortior, U. S.; Liquor Ammonia? Fortis, B. P.), containing 28 per 
cent, by weight of the gas, and the weaker water (Aqua Ammonia?, 
U. S.; Liquor Ammonia?, B. P.), which should contain about 10 per 
cent, by weight of the gas. The spirit of ammonia (Spiritus Ammonia?, 
U. S.) is given in the dose of 30 to 60 minims (2.0-4.0) in water, and 
the aromatic spirit of ammonia (Spiritus Ammonia? Aromaticus, U. S. 
and B. P.) in the dose of 30 to 60 minims (2.0-4.0) in water. The 
latter preparation is composed of carbonate of ammonium, the oils 
of nutmeg, lemon, and lavender, with alcohol and ammonia-water. 
Spiritus Ammonia? Fa?tidus (B. P.) contains asafcetida, and is used in 
place of the aromatic spirit. Ammonia liniment (Linimentum Am- 
monia?, U. S. and B. P.) is used over tender joints and muscles. 

AMMONIAC. 

Ammoniac (Ammoniacum, B. P.) is a resinous gum obtained from 
Dorema Ammoniacum, and is little used in medicine at the present 
time. Internally and externally it produces some irritation when 
brought in contact with the tissues, and may be used internally in the 
dose of 10 to 30 grains (0.60-2.0) in pills in cases of chronic bronchitis 
devoid of any active inflammatory process. Mistura Ammoniaci (B. P.) 
is used in chronic bronchitis in the dose of a tablespoonful (15.0). 



80 DBUGS. 

AMMONIUM (NH 4 ). 

The following salts of ammonium are official, and are used for 
various purposes: 

Acetate of Ammonium. 

Acetate of Ammonium is used in medicine in the form of the spirit 
of Mindererus (Liquor Ammonii Acetatis, U. S. and B. P.), dose 1 to 
2 fluidrachms (4.0-8.0), for the purpose of acting as an antacid in 
gastric indigestion, and also as a mild diaphoretic which is inferior 
to sweet spirit of nitre. 

Benzoate of Ammonium. 

Benzoate of Ammonium (Ammonii Benzoas, U. S. and B. P.) is 
employed chiefly for its diuretic influences, which depend entirely 
upon the benzoic acid present in the compound. It should be kept 
in well-stoppered bottles. As benzoic acid is eliminated as hippuric 
acid and ammonia as nitric acid, this drug may be employed in cases 
where the physician desires to make the urine decidedly acid; as, for 
example, in patients suffering from catarrh of the bladder, when the 
urine is loaded with phosphates, which are dissolved by this acidula- 
tion. The dose is 10 to 30 grains (0.60-2.0), which should be dis- 
solved in water, or, better, administered in cachets or capsules. 

Bromide of Ammonium. 

Bromide of Ammonium (Ammonii Bromidum, U. S. and B. P.) is 
really a crystalline salt, but is generally found in commerce as a white 
granular powder, which, when exposed to the atmosphere, becomes 
slightly yellowish. It is readily dissolved in water. 

Physiological Action. — Applied to the mucous membrane of the 
mouth, the bromide of ammonium produces a salty taste, is markedly 
pungent, and dissolves readily in the oral secretions. If large amounts 
are swallowed, it causes burning pain in the belly and evidences of 
gastro-enteritis. 

Nervous System. — The action of this drug upon this part of the 
body is its most important effect. Given to the lower animals, it pro- 
duces in frogs total loss of reflex activity, preceded, it is said, in some 
cases by tetanic convulsions, although no such motor disturbances 
may take place. In a series of studies undertaken by the writer to 
determine the effect of the drug it was found that the spinal cord was 
depressed, both on its motor and sensory sides, while the nerves and 
muscles escaped. These results are in accord with those of other 
investigators, who also found that the nerves are unaffected. On the 
cerebral cortex it acts as a distinct sedative. 

Circulation. — Upon the circulation bromide of ammonium acts 
as a stimulant in small doses, but as a cardiac paralyzant if a large 



AMMONIUM. 81 

amount comes in contact with the heart. In medicinal dose it is 
distinctly stimulant to the circulation, but not sufficiently so to render 
it valuable as a circulatory stimulant, to the exclusion of other more 
powerful preparations. 

Therapeutics. — The bromide of ammonium may be used in nearly 
every instance where bromide of potassium may be employed, and 
possesses the distinct advantage of being less depressant to the general 
system than the latter drug. It is, however, more apt to disorder the 
stomach even if given in moderate doses. In epilepsy it would seem 
to be of as much value as the potassium salt, and may be combined 
with it in some cases with success. (See article on Epilepsy, Part IV.) 
According to J. M. Da Costa, the drug is of distinct value in rheu- 
matism in the dose of 60 to 80 grains (4.0-5.3) a day, well diluted with 
water, although its manner of action in this disease is not known. The 
usual dose is 10 to 30 grains (0.60^2.0). It is incompatible with spirit 
of nitrous ether. 

Carbonate of Ammonium. 

Carbonate of Ammonium (Ammonii Carbonas, U. S. and B. P.) 
undoubtedly has an action exactly like that of the liquid preparations 
of ammonia, and is used either alone or with the chloride in the treat- 
ment of bronchitis, particularly when this disease occurs in babies and 
young children. It is also largely employed by surgeons in the treat- 
ment of children after a surgical operation to overcome the respiratory 
and circulatory depression produced by the anaesthetic. The dose 
is 2 to 10 grains (0.12-0.60) in syrup of acacia and water. It is a 
rapidly acting cardiac and respiratory stimulant. 

Bf — Ammonii carbonat , gr. xlviij (3.2). 

Syrup, acacise f§j (30.0). 

Aquae dest ". . q. s. ad f Siij (90.0). — M. 

S. — Teaspoonful (4.0) every two hours for a child of three or four years. 

Chloride of Ammonium. 

The Chloride or Muriate of Ammonium (Ammonii Chloridum, U. S. 
and B. P.) has an entirely different action and therapeutic use from 
the rest of this group. It possesses almost no influence over the heart 
and respiration, but does exercise a very stimulant effect on mucous 
membranes, increasing the secretion of mucus. The consideration of 
its use in diseases of the lungs can be found in the articles on Pneu- 
monia and Bronchitis. Chloride-of-ammonium fumes can be obtained 
from a few grains of the drug heated in an iron spoon over a gas-jet 
or by means of a set of three wash-bottles. In one of these is placed 
stronger water of ammonia, in another muriatic acid. Each of these 
is connected with a third bottle by means of glass tubing, this bottle 
being partly filled with water, through which the fumes in passing 
become purified and form the fumes of chloride of ammonium. The 
drug may also be used in a spray from an atomizer. Where it is 

6 



82 DRUGS. 

desirable to maintain the effect of the drug over a long period of time, 
as in chronic bronchitis, the following method may be followed, as 
recommended by Mew: A soup-plate is placed upon the floor of the 
room, and from 3 to 4 ounces (90.0-120.0) of sulphuric acid are placed 
in it. Into a neighboring saucer are poured 2 ounces (60.0) of strong 
ammonia, and then about a tablespoonful (15.0) of ordinary table- 
salt is sprinkled upon the acid. In less than a minute the room 
becomes filled with dense fumes of nascent chloride of ammonium, 
which can be readily maintained by renewed charging of the soup- 
plate and saucer. In this way the patient may be made to inhale 
chloride of ammonium fumes for a long period of time with very advan- 
tageous results. This is a particularly useful method in cases of fetid 
bronchitis. 

Chloride of ammonium has been employed in intermittent fever, 
but has gone out of use, and has also been vised in neuralgias of the 
ovarian type by Goodell and others. In the treatment of chronic 
torpor of the liver and subacute hepatitis, and even in cirrhosis and 
hepatic abscess, it has been thought of value. Many clinicians have 
found it useful in the treatment of the gastric and intestinal catarrhs 
of children of a very subacute type, and it is the routine treatment 
for all such cases which come under observation at the hospital and 
elsewhere where the author has charge. The dose is 2 to 15 grain:; 
(0.12-1.0), preferably given with liquorice and water to mask the taste. 

R — Ammonii chloridi gij (8.0). 

Fluidextracti glycyrrhizae f,^j(30 0) 

Aquae dest q. s. ad f'giij (9U.0). — M. 

S. — Teaspoonful (4.0) t. i. d. after meals for a child of five to ten years. 

The chloride of ammonium may, however, be given in compressed 
tablets, provided a large draught of water or milk is taken simulta- 
neously to protect the stomach. (See article on Bronchitis for other 
prescriptions.) 

Gillespie asserts that 10 grains (0.60) of chloride of ammonium 
given half an hour before meals gives extraordinary relief in painful 
dyspepsia due to hyperacidity of the stomach. 

Chloride of ammonium, in a lotion of the strength of 1 ounce (30.0) 
to 2 quarts (2 litres) of water, is an efficient remedy for the dermatitis 
caused by poison-ivy. 

Iodide of Ammonium. 

Iodide of Ammonium (Ammonii Iodidum, U. S.) should be kept 
in dark, well-stoppered bottles, and if deeply colored should not be 
dispensed. It may be employed in the dose of 2 to 5 grains (0.12-0.3) 
in all cases where the iodide of potassium is indicated, and seems to 
possess alterative influences equal to those of that salt. It has been 
r commended as a local application in cases of enlarged tonsils in the 
form of a solution of 30 grains (2.0) of the salt to the ounce (30.0) 



AMYL NITRITE. 83 

of glycerin, particularly if struma is the cause of the enlargement. 
The application is to be made once a day with a swab or camel' s-hair 
brush. It is necessary that this solution be not exposed to the air or 
it will undergo decomposition. 

Valerate of Ammonium. 

Valerate of Ammonium (Ammonnii Valeras, U. S.) is the salt 
of ammonium commonly used in the nervous unrest of pregnant or 
hysterical women, or at the menopause in the peculiar nervous dis- 
orders apt to occur at that period. In poisonous doses it paralyzes 
the spinal cord in the lower animals. It is usually given in the form 
of the elixir of valerate of ammonium, the dose of which is a tea- 
spoonful to a dessertspoonful, or it is combined with the bromides, 
under which circumstances it is much more efficacious. The dose of 
the salt itself is 10 to 15 grains (0.60-1.0). 

The sulphate of ammonium is never used in medicine. The phos- 
phate of ammonium is employed in rheumatism in the dose of 10 to 
20 grains (0.60-1.3). It is no longer official. 

The B. P. preparations besides those already given are: Oxalate 
of Ammonium and Liquor Ammonii Citratis, dose 2 to 6 fluidrachms 
(8.0-23.0). 

AMYL NITRITE. 

Amyl Nitrite (Amyl Nitris, U. S. and B. P.) is a very volatile, 
somewhat oily liquid possessing a peculiar penetrating pear-like odor. 
It is made by the action of nitric and nitrous acids upon amylic alcohol, 
and is not to be confounded with nitrate of amyl, which has a different 
physiological action and is never used medicinally. 

Nitrite of amyl should be protected from light and heat. 

Physiological Action. — When swallowed or inhaled, the drug pro- 
duces staggering, fulness in the head, roaring in the ears, duskiness 
of the face, and finally complete muscular relaxation, so that the 
animal or man falls to the ground. The heart beats very rapidly and 
forcibly, and the respiration becomes gasping. 

Nervous System. — Nitrite of amyl is the most rapidly acting of 
all the nervous depressants and sedatives known, except prussic acid. 
Experiments show that its dominant action is on the motor side of 
the spinal cord. The motor cortex of the brain and the motor nerves 
are only affected by large amounts. Upon the nervous apparatus of 
sensation nitrite of amyl has no effect in medicinal amounts, and 
should never be used to relieve pain unless it be due to spasm or to 
angina pectoris. The muscles are depressed by toxic amount. 

Circulation. — When nitrite of amyl is used, the pulse becomes 
exceedingly rapid, while the arterial tension progressively falls. The 
increase in pulse-rate is due to depression of the centric inhibitory 



84 



DRUGS. 



Fig. 8. 




V 



V 



apparatus (vagus centres) of the heart and to the sudden relaxation 
of the bloodvessels, by reason of which, the resistance being taken 
away, the heart beats faster. The fall of arterial pressure is due to 
depression of the vasomotor centres and the muscular coats of the 
bloodvessels. In very small amounts the drug stimulates the heart- 
muscle (Reichert), but its dominant action is that of a depressant. 

The Blood. — In medicinal dose this drug produces a chocolate 
color of the arterial blood, due to the change of oxyhemoglobin into 
methsemoglobin. 

Urine and Elimination. — The urine sometimes contains sugar 
after the use of the nitrite of amyl, and there is increased diuresis. 
The drug is eliminated very rapidly from the body 
by the lungs and kidneys. 

Temperature. — If the nitrite of amyl be employed 
for any length of time, a most remarkable fall in 
bodily temperature ensues, which is probably due to 
diminished oxidation, but possibly to some effect on 
the heat-centres governing heat-production and dissi- 
pation. The vascular dilatation also tends to aid 
greatly in the loss of bodily heat produced by the 
drug. 

Therapeutics. — Nitrite of amyl is used to relax 
general or local muscular spasms, for the relaxation 
of the spasm of epilepsy and for aborting an on-com- 
ing fit, for the prevention and subjugation of strych- 
nine convulsions and tetanus, and for the relief of 
angina pectoris, provided the attack is accompanied 
by high arterial tension. It may be used in puerperal 
of' amyl de- eclampsia, but it is a dangerous remedy because of 
presses the motor or its relaxation of the uterus and the consequent danger 
crossed pyramidal £ p 0S t-partum hemorrhage. In dysmenorrhea with 

tracts of the spinal r . r • p • T > xt» ■ 

cord. uterine spasm it often gives great relief. Nitrite of 

amyl has been used in cases of sea-sickness as a 
prophylactic and cure with considerable success. In cardiac fail- 
ure from fright or anaesthetics amyl nitrite is often of great value 
in single whiffs. If it does not act at once under these circumstances, 
it is worse than useless to push it. . It has also been found of value 
in whooping-cough, laryngismus stridulus, asthma, spasmodic croup, 
and infantile convulsions. In migraine with local vasomotor spasm 
and true hemianopsia it is very useful. In strychnine poisoning and 
tetanus it must be used between the spasms or else given hypoder- 
mically, as the respiratory cramp prevents its inhalation. 

Administration. — The drug may be given by placing three to five 
drops on a handkerchief and inhaling the fumes, or it may be dropped 
on sugar and taken by the mouth in the same quantity. 

It is important to remember the fact that the effects of the drug 
are more severe for a moment after its use than during its inhalation. 



V 



V 



Nitrit< 



ANTIMONY. 85 

The physician should warn the patient that the effect of the drug- 
is sudden and alarming, and in nervous cases should direct that the 
inhalations be made slowly, as a very full inhalation may produce 
unpleasant sensations of cardiac failure. 

The best way for patients to use the drug is to have it in pearls of 
glass, each holding 3 minims (0.15). One or more of these may be 
crushed in a handkerchief and the fumes inhaled. Some of the 
pearls made by careless manufacturers are of such thick, strong glass 
that they are difficult to break, and if broken are apt to cut the fingers. 
These are, of course, to be avoided. 

ANTHRAROBIN. 

Anthrarobin seems to possess equal value with its relative chrys- 
arobin, and to be capable of acting as efficaciously as this substance 
in the treatment of skin diseases. It is a yellowish powder, tolerably 
stable in a dry atmosphere, not soluble in acids or water, but readily 
soluble in dilute alkaline solution or alcohol, at first making a solution 
of a brown color, which, as oxygen is taken up, changes to a green 
and finally to a violet. 

Therapeutically, anthrarobin has been employed by Rosenthal and 
by Behrend, and more recently Kobner has recorded his experience 
with it, employing it with good results in a 10 to 20 per cent, solution 
in the various forms of tonsurans as a wash. Rosenthal has used it in 
psoriasis and pityriasis versicolor and herpes, and Behrend asserts 
that it is often better in its effects upon the skin than chrysarobin, as 
it produces less inflammation and discolors the skin only slightly. It 
also possesses the additional value of making so slight a stain on the 
linen that it can be removed by washing. 

According to most authorities, it is best to keep the drug in alcoholic 
solution, and, if the bottle is well corked, such a mixture remains stable 
for a week. 

ANTIMONY. 

Antimony itself is rarely used in medicine, owing to its insolubility, 
but is generally employed as the tartrate of antimony and potassium, 
or Tartar Emetic (Antimonii et Potassii Tartras, U. S.; Antimonium 
Tartar alum, B. P.), or in the form of the sulphide (Antimonii Sul- 
phidum); purified sulphide (Antimonii Sulphidum Purificatum; Anti- 
monium Nigrum Purificatum, B. P.); and sulphurated antimony 
(Antimonium S ulphuratum, B. P.), sometimes called Kermes Mineral. 
The last three drugs are very rarely employed and are unreliable 
preparations, although some practitioners use kermes mineral as an 
alterat've circulatory depressant and sedative expectorant in the dose 
of -g- grain (0.01) every hour or two. As an emetic the dose of 
Kermes Mineral is 1 to 4 grains (0.06-0.25). 

The oxide of antimony (Antimonii Oxidum, B. P.) forms part of 
the Pidvis Antimonialis , 



86 



DRUGS. 



Fig. 9. 



Tartar Emetic. 

Tartar Emetic (Antimonii et Potassii Tartras, U. S.; Antimonium 
Tartaratum, B. P.) is made by boiling the oxide of antimony with 
bitartrate of potassium and water. Although it is really crystalline, 
it is generally sold as a fine powder, owing to the crystals being 

easily pulverized. It is insoluble 
in absolute alcohol, but is soluble 
in ordinary water, and still more 
so in boiling water. In dilute 
alcohol it is partly soluble. 

Owing to its chemical consti- 
tution tartar emetic should never 
be given with either acids or alka- 
lies, and all drugs containing tan- 
nic acid are also incompatible 
with it, owing to the fact that 
an insoluble tannate is rapidly 
formed, which is absorbed very 
slowly if at all. So complete is 
the insolubility of the compound 
so formed that tannic acid is the 
best antidote to the drug that we 
possess. 

Physiological Action. — Tartar 
emetic, when applied to mucous 
membranes, produces a burning 
sensation, and upon the skin it 
may readily cause intense irrita- 
tion if the part be delicate. If 
kept in contact with a mucous 
membrane, very distinct inflam- 
matory changes occur, and if it 
be applied to the skin for any 
length of time, redness, followed 
by acne of a pustular character, 
appears, which finally ends in 
ulceration and sloughing if the 
use of the drug is persisted in. 
Under these circumstances the 
vitality of the parts seems interfered with, and, as a result, healing 
takes place very slowly indeed. 

Nervous System. — Antimony is a depressant to the sensory side 
of the spinal cord and a paralyzant to all the spinal centres, motor 
and sensory, in poisonous dose. 

It is stated that when an animal is under its influence sensation to 
heat and acids is lost before the ordinary sense of touch is destroyed. 




A, antimony depresses the heart-muscle; B, 
antimony depresses the peripheral portions of 
the vasomotor system in the bloodvessels; C, 
antimony depresses the vasomotor centre; D, 
the respiratory centre. 



ANTIMONY. 



87 



Fig. 10. 



The convulsions which sometimes ensue after poisonous doses in the 
lower animals are due to anaemia of the brain brought on by the cir- 
culatory depression. Ringer and Murrell have proved antimony to 
be a motor-nerve and muscle poison. 

Circulation. — The chief influence of antimony is exerted upon 
the circulation. In small doses it lowers the pulse-rate by a direct 
depression of the heart-muscle, and simultaneously decreases arterial 
tension by an action upon the peripheral portions of the vasomotor 
system in the walls of the bloodvessels, but the vasomotor influences 
may be in part centric, and this question must be considered as sub 
judice. The fall of arterial pressure is also due to failure of heart- 
force. With the lowering of the pulse-rate there is nearly always a 
corresponding decrease in cardiac power. 

When poisonous doses are employed, death ensues after great cir- 
culatory and respiratory depression, as will be seen below. The heart 
is found after death relaxed and 
flabby and wholly unresponsive to 
all stimuli, although in one of the 
lower animals, such as the frog, if 
the dose has not been very excessive 
and digitalis is freely employed, the 
heart may be made to beat again. 
In man, it is hardly necessary to 
state, the digitalis must be used early 
to render much service. The drug 
in poisonous doses is thought to de- 
press the peripheral ends of the vagus 
nerves. 

Respiration. — The drug has little 
or no effect upon respiration except 
when given in lethal doses. Under 
these circumstances death is pro- 
duced in three ways, all of them 
acting together. Primarily, the res- 
piratory centre in the medulla is de- 
pressed, and the governing nerves of breathing, the pneumogastrics, 
are also rendered inactive; secondarily, the cardiac failure readily 
causes pulmonary congestion; and, thirdly, the drug causes such an 
outpouring of liquid mucus into the bronchial tubes that the patient 
is drowned in his own secretions, which he is too weak to expel. 

Stomach and Intestines. — Antimony in toxic doses is a powerful 
irritant to these portions of the body In full medicinal amounts it 
acts as a slow but powerful emetic, producing much nausea. The 
vomiting is due to an action on the vomiting centre in the medulla 
and to a direct action on the stomach itself. The drug is, therefore, 
a centric and peripheral emetic. Very full doses produce watery 
purging, attended with some griping and tenesmus. 




A, antimony stimulates the vomiting 
centre; B, antimony irritates the gastric 
mucous membrane. 



88 DRUGS. 

Elimination. — Antimony escapes from the body in all the secre- 
tions, but largely by the bowels. The latter method of elimination 
seems chiefly to follow poisonous doses, and purging is an effort at 
elimination. 

Therapeutics. — Tartar emetic is employed for at least five separate 
purposes, the most usual of which is as a circulatory quieter and seda- 
tive. The indications for antimony as a circulatory depressant are not 
so generally recognized at present as they were at one time, on account 
of the introduction of other drugs. All states of sthenic inflammation 
with a bounding pulse, high fever, and symptoms showing the patient 
to be possessed of robust constitution permit of its use, while all 
asthenic conditions most emphatically contraindicate its employment. 
In the treatment of colds, to break forming diseases, and to allay 
inflammation it is given in moderate dose. It is useful in sthenic 
bronchitis as an expectorant. Under these circumstances it may be 
given in emetic dose; or, if emesis is not desirable, minute amounts 
given hourly are of value, such as -^ grain (0.001) every hour, or a 
teaspoonful of a solution of \ grain (0.03) to 4 ounces (120 c.c.) of 
water every hour may be used. This is a particularly useful method 
in children, as the solution is tasteless and it does not produce nausea 
and vomiting. 

In the acute catarrh of children, which affects the stomach and entire 
alimentary canal and is associated with little fever, the use of the drug 
is extremely valuable, and often aborts an attack when given in the 
same dose as just described. 

As an emetic antimony is slow but forcible. It ought not to be used 
in cases of poisoning by other drugs, owing to its slowness of action. 

Before the introduction of anaesthetics emetic doses were employed 
to relax the muscles in reducing dislocations and fractures. 

Tartar emetic is harmful if irritation of the stomach is present or 
if kidney changes are rapidly progressing. If one good-sized emetic 
dose is not sufficient to produce vomiting, it should not be repeated, 
but some other emetic or the stomach-pump be used, lest antimonial 
poisoning complicate the case. The emetic dose must be large enough 
to be effective, or none at all should be given. If this rule is dis- 
regarded, systemic changes come on with undesirable severity in those 
cases where emesis fails to occur because of small doses. 

As a counterirritant antimony is employed in the form of an oint- 
ment whenever a very slowly acting and prolonged counterirritation 
is to be maintained, as on the back of the neck in epilepsy or similar 
chronic states, and in old enlargements of the joints. 

Antimony acts well as a diaphoretic, but its use is undesirable, owing 
to its disagreeable effects, such as nausea and intestinal disturbance, 
and because other, more pleasant, drugs act equally well. 

Administration. — The dose of tartar emetic when there is an excited 
circulation is 2V to tV g ram (0.003-0.006) every three hours until 
an effect is obtained. As an emetic the dose is h to 1 grain (0.03-0.06), 



ANTIMONY. 89 

The wine of antimony (Vinum Antimonii, U. S.; Vinum Antimoniale, 
B. P.) contains only 2 grains of tartar emetic to each ounce, and may 
be used in the dose of 15 to 30 minims (1.0-2.0), or as an emetic in 
the dose of 2 to 4 drachms (8-16). The compound pill of antimony 
(Pilules Antimonii Composites, or Plummets pill) is used as an 
alterative, and contains sulphurated antimony \ grain (0.03), calomel 
\ grain (0.03), guaiac 1 grain (0.06); the dose is one to three pills. 

The ointment of antimony (Unguehtum Antimonii Tartarati) is 
used externally as a counterirritant spread on a rag or piece of lint. 
Antimonial powder (Pulvis Antimonialis , B. P.), or James's pow- 
der, contains oxide of antimony and phosphate of calcium, and is 
given occasionally as an antipyretic in the treatment of rheumatism 
and fever in the dose of 3 to 10 grains (0.20-0.60) ; it is best given 
in a pill. 

The compound syrup of squill (Syrwpus Scillce Compositus, U. S.), 
otherwise known as "Coxe's Hive Syrup/' contains f grain (0.045) of 
tartar emetic to the ounce. The dose is 20 to 30 minims (1.3-2.0) 
for an adult as a sedative, or from this amount to 1 drachm (4.0) 
to a child as an emetic. 

Poisoning. — When toxic doses of tartar emetic are taken, the pulse 
at first becomes slightly weaker and slower, the skin becomes moist and 
relaxed, a general sense of relaxation comes on, and simultaneously a 
sensation of severe nausea and gastric distress appears. 

Following this condition violent vomiting asserts itself. The ejected 
mass consists of the contents of the stomach — mucus, bile, and watery 
fluids, perhaps blood. Purging appears almost as early as the vomiting, 
and consists first of the normal contents of the intestines, then mucus, 
then bile, and, very rarely, blood. These signs may rapidly pass 
away and the characteristic peculiar " rice-water" stools 1 of antimonial 
poisoning appear. The general condition of the patient is now most 
serious. The face is pinched, livid, and covered with a cold sweat. 
The pulse is rapid and shuttle-like — to and fro — or lost at the wrist; 
the arterial tension is almost nil. The respirations are faint and 
fluttering, and so shallow as hardly to be seen or heard. Cramps 
in the calves of the legs attack the patient, due to the abstraction of 
water from the tissues by the violent purging, and the temperature 
falls lower and lower as death approaches. The general condition is 
such that all the signs point to Asiatic cholera, and antimonial poison- 
ing cannot be distinguished from this disease during an epidemic 
without a history of the case or a chemical analysis of the secretions, 
which ought always to be preserved. 2 

1 A "rice-water" stool is one which, on standing in a glass, separates into two layers, the lower 
white and flocculent, the upper watery and almost clear. 

2 This is a good opportunity to state that the secretions and excretions of a person dying of 
any poison should be placed in a chemically-clean jar capable of being sealed. The same rule 
of cleanliness applies to the jars holding organs at the post-mortem. The jars should be at 
hand, and no intermediate vessel used. They should be sealed at once, and kept so until claimed 
by the authorities. 



90 DBUGS. 

The treatment of antimonial poisoning consists in the internal 
administration of large amounts of tannic acid to form the insoluble 
tannate of antimony, in the use of the stomach-pump, and in the 
maintenance of an absolutely prone position. When tannic acid 
cannot be had, ordinary tea-leaves may be boiled and the decoction 
given as an antidote and stimulant. The patient should vomit into 
towels and not raise the head from the pillow; the head, indeed, 
should generally be placed lower than the heels. External heat, 
alcohol, and digitalis should be used freely, and opium should be 
employed hypodermically to allay pain and irritation unless the 
respirations are too feeble. If the opium is greatly needed because 
of pain, and yet seems contraindicated because of depression, it should 
be accompanied by strychnine to stimulate the respiratory centre and 
overcome any depression produced by the opium. 

Fatty degeneration of all organs may occur after acute antimonial 
poisoning. 

Chronic poisoning by antimony is quite a rare affection, but it occurs 
chiefly in type-founders and type-setters. Mc Walter has reported 
instances in which peripheral neuritis, disorders of the bladder, and 
irritability of the prostate developed in these artisans. Headache, 
abdominal tenderness, and an irritable state of the mucous mem- 
branes were also present, associated with profound mental depression 
and circulatory feebleness. These facts are of interest because it is 
a superstition among some of the lower classes that the administration 
of antimony will cure the alcoholic habit, and if given for a long time 
these symptoms and fatty degeneration might ensue, leading to a sus- 
picion of attempted murder by poison. 

ANTIPYRIN. 

Antipyrin (Antipyrinum, U. S.; Phenazonum, B. P.) is a derivative 
of coal-tar, its chemical name being phenyldimethylpyrazolon. It 
was discovered by Ludwig Knorr in 1884, and introduced into medi- 
cine by Filehne. Antipyrin is a white powder of a somewhat bitter 
taste, and is very soluble in water, less so in ether, alcohol, and chloro- 
form. 

When antipyrin is given to a man in full medicinal amount, it causes 
a sensation of buzzing and tightness of the head not unlike that pro- 
duced by quinine. The bodily temperature, if normal, is depressed 
a fraction of a degree, but no other symptoms are manifested. If the 
dose be quite large, some blueness of the lips and finger-nails appears, 
chilly sensations are experienced, and finally a profuse sweat breaks 
out over the entire body, which is more severe if fever has previously 
existed. Large doses sometimes cause nausea and vomiting. 

Physiological Action. — Nervous System. — When a large poisonous 
dose of antipyrin is given to one of the lower animals, relaxation, com- 
plete loss of reflex action, and total inability to move come on at once, 



ANTIPYRIN. 91 

and death ensues. Somewhat smaller doses produce exceedingly severe 
tetanic and epileptiform convulsions, but consciousness seems to be 
preserved. It has been proved that the chief cause of the convul- 
sion is an action of the drug on the brain. 1 Very large toxic doses, 
therefore, decrease reflex action, and smaller ones increase it, though 
medicinal amounts certainly lessen reflex activity to a notable degree. 
The cause of this failure of reflexes is depression of the sensory nerves 
and the receptive centres of the spinal cord. Medicinal amounts 
must, therefore, be regarded as very distinct nervous sedatives, acting 
much more actively on the nerves of sensation than on those of motion. 
Injected beneath the skin or applied to a mucous membrane, antipyrin 
is a powerful local anaesthetic, the anaesthesia lasting often for several 
days. 

Circulation. — The studies of a very large number of pharma- 
cologists prove most conclusively that antipyrin has no effect on the 
circulation of the lower animals in moderate doses unless these be so 
frequently repeated that cumulative effects ensue. Many reliable 
clinical observers have asserted that the drug depresses the circula- 
tion in man in some cases, and antipyrin is certainly not a cardiac 
stimulant. The writer is confident, however, that antipyrin is not so 
distinctly a cardiac depressant as some believe. On the other hand, 
there can be no doubt that in some persons it tends to lower arterial 
tension and so to produce syncope. It must therefore be used with 
caution in cases which have a feeble circulation. Large, poisonous 
doses lower blood-pressure unless convulsions are present, when the 
pressure is raised. In many of the cases where vascular depression 
and collapse have followed its use it has been employed in excessive 
amounts or the fall in bodily temperature has caused the untoward 
symptoms. (See Fever and its Treatment.) 

Blood. — No spectroscopic changes in the blood follow the use of 
medicinal doses of antipyrin in the ordinary individual, but in poison- 
ous amounts it produces methsemoglobin. If the doses be toxic or 
idiosyncrasy exists, cyanosis may come on. That the blood is not 
destroyed by small amounts is proved by the absence of hsematin in 
the urine of persons taking the drug. The corpuscles suffer no changes 
except in very pronounced poisoning, when they are said to become 
crenated and shrivelled. 

Respiration. — When antipyrin is given in lethal doses, death 
results from failure of the respiratory centre. Ordinary doses have 
no effect on this function, but large ones make the breathing more 
rapid. 

Temperature. — In normal men and animals antipyrin in medici- 
nal dose may be considered as without effect so far as bodily tempera- 
ture is concerned. In fevered animals it has been found to lower 
temperature by decreasing heat-production and increasing heat-dissi- 

1 See author's Boylston Prize Essay of Harvard University, on Antipyretics. 



92 DRUGS. 

pation. That it does not do this by an action on the blood seems 
proved by the fact that the blood is not affected by medicinal amounts. 
The sweating does not cause the fall since it takes place when no 
sweating occurs. It may, therefore, be considered that the drug 
directly affects the nervous heat-mechanism of the body. 

Kidneys, Tissue-waste, and Urine. — A large number of studies 
made upon man and the lower animals by competent investigators 
have brought about very considerable advances in our knowledge of 
the influence of antipyrin upon tissue-waste. It is useless to burden 
this volume with a discussion of their methods and results, which may 
be found in the author's Essay on Antipyretics. Suffice it to say that, 
while all observers are not agreed as to the effects produced, the deduc- 
tions apparently to be drawn are that the drug diminishes the quan- 
tity of the urine excreted, and also decreases the elimination of the 
results of nitrogenous tissue-metamorphosis — or, in other words, is a 
conservator of the tissues of the body. 

Elimination. — The elimination of antipyrin goes on very rapidly 
indeed, and begins almost at once after its ingestion. Maragliano and 
Reihlen state that it appears in the urine in three hours after it is 
taken, so that at the fourth hour elimination is at its height, although 
it continues to be eliminated for twenty-four or perhaps thirty-six 
hours. According to Pavlinow, part of the antipyrin ingested is elim- 
inated by the salivary glands. 

Poisoning. — The treatment of poisoning by antipyrin consists in 
the administration of stimulants, the maintenance of bodily heat, the 
use of atropine to restore the tone of the vascular system, and, if 
cyanosis is alarming, the employment of oxygen inhalations. 

Antiseptic Power. — Antipyrin exerts a very distinct antiseptic action 
in small amounts, delays all forms of fermentation, and destroys germs 
when it is present in large quantity. 

Therapeutics. — Antipyrin is employed in medicine for two great 
purposes — namely, for the reduction of fever and the relief of pain — 
but its employment as an antipyretic is now surpassed by its use as an 
analgesic. 

As an antipyretic, antipyrin should be given in a few full doses 
rather than frequent small ones, as a general rule, since if the fever 
is of any severity the latter method of administering it will have no 
effect, and the constant dosing will produce a gradual saturation of the 
system without causing a fall of temperature. On the other hand, too 
large doses may depress the temperature to a point below normal and 
induce collapse. In the article on Fevers (Part IV.) the conditions 
are indicated in which the drug is best employed, these being the 
sthenic fevers as a rule, or instances where excessive outbursts of fever 
necessitate prompt reduction of temperature. In excessively high 
temperature in pneumonia it may prove of value, and in scarlet fever 
and smallpox antipyrin is occasionally of service, although in pneu- 
monia, as a rule, the condition of the patient indicates the use of cold 



ANTIPYRIN. 93 

to the chest as a local measure for the reduction of congestion or cold 
sponging to relieve fever. (See Pneumonia.) The use of the cold 
applications is always to be preferred to antipyrin in the reduction 
of fever, since, they are safer, more reliable, and do not strain the 
kidneys, reduce the blood, or depress the heart in feeble patients. (See 
Cold and Fever.) When cold water cannot be used, then antipyrin 
may be employed. In phthisis antipyrin generally increases the sweat- 
ing, produces oppression, and either fails to act as an antipyretic or 
causes collapse by exercising too great an effect. In sunstroke it 
frequently fails to influence the temperature, and ought not to be 
used. 

Be the fever what it may, provided it be associated with any dis- 
ease process, antipyrin is useless so far as any influence over the course 
of the disease itself is concerned. It is a remedy to be used in the 
treatment of the symptoms, not for the removal of the cause of the 
fever. 

As an analgesic antipyrin is the peer of opium. Although the 
latter drug will relieve all forms of pain if it be pushed, it possesses 
many disadvantages not found in antipyrin. In deep-seated pains due 
to disease of the organs of the body, in inflammations and similar dis- 
turbances, antipyrin is useless. In neuralgic affections of all kinds it 
finds its sphere, particularly if the disorder be rheumatic, gouty, or due 
to nervous depression from nervous exhaustion or disease. Under the 
latter circumstances it is best combined with caffeine and a little bromide 
of potassium. (See Neuralgia.) In rheumatism it will give relief in a 
fairly large number of cases, not only relieving the pain and fever if 
they be present, but also actually modifying the disease. It seems, 
however, to increase sweating in acute articular rheumatism. In gout 
it is stated to have a specific curative effect upon the disease over and 
above the relief of the pain, but this is questionable. Its use in dys- 
menorrhea has been recommended, but its beneficial influence in such 
cases is doubtful. At one time it was thought that its use would 
relieve the pains of labor entirely, but this has, unfortunately, proved 
untrue. It may, however, be tried, when the suffering is very severe, 
in the dose of 15 grains (1.0). In the severe lancinating or dart- 
ing pains of locomotor ataxia, and in the laryngeal and gastric 
crises complicating this disease antipyrin is an invaluable remedy. 
Curiously enough, it seems to subdue acute attacks of pain in posterior 
sclerosis, but fails to control the slighter pains and muscular twitchings 
sometimes seen in this disease and in myelitis. 

Some clinicians have used antipyrin with asserted great success in 
diabetes mellitus. In such instances the disease often depends on a 
gouty diathesis, and can be well relieved by salicylates. 

Antipyrin may be used hypodermically in the region of a hypersen- 
sitive nerve as a local anaesthetic. The anaesthesia produced by it lasts 
for several days, but the pain immediately after the injection is severe, 

Antipyrin is a very useful remedy in epilepsy. (See Epilepsy.) 



94 DRUGS. 

In whooping-cough antipyrin has more frequently given relief in the 
writer's experience than any other remedy. It should be given to a 
child of five years in the dose of 2 grains (0.12) every four or five hours, 
the patient being watched for cyanosis and the drug stopped as soon as 
this symptom appears. Antipyrin generally decreases the frequency 
rather than the severity of the attacks of cough. 

In malarial diseases antipyrin certainly exercises no antiperiodic 
influence, although it controls the febrile paroxysms to a great extent. 
Yet, while this is the opinion of the majority of those who have used 
it, it cannot be said that every observer has reached similar conclu- 
sions,, Potter reports cases where the results obtained from its use were 
most satisfactory, particularly in the intermittent form of malarial 
poisoning. One cannot help thinking that frequently where antipyrin 
has been reported as acting as an antiperiodic it has simply lowered the 
fever, and so seemed to influence the disease. 

In acute coryza the temporary relief produced by applying cocaine 
to the engorged Schneiderian membrane may be prolonged indefinitely 
by the use of a spray of antipyrin in the strength of 4 per cent. This 
produces a smarting sensation, which speedily passes away. The same 
treatment is of value in inflammations of the larynx and pharynx. 
Should cocaine solutions not precede the antipyrin, the primary irritant 
effects persist unless the strength of the solution of antipyrin is reduced 
to 1 or 2 per cent. It is always better to precede its use by cocaine. 

Locally applied, antipyrin possesses very distinct hemostatic prop- 
erties, and for this purpose may be used in a 4 per cent, solution, either 
in liquid or in a spray. Under these circumstances it seems to act not 
by producing clots, which are disadvantageous from the standpoint of 
antisepsis, but by constringing the bleeding vessels. This haemostatic 
property is very materially increased if a solution of tannic acid is 
added to it, when it forms a glutinous precipitate which controls the 
hemorrhage. The precipitate is best applied by means of a swab. 

Antipyrin may be given with cocaine in suppository to check bleed- 
ing from hemorrhoids and relieve rectal pain. The cocaine must be 
used to prevent the antipyrin from causing pain when the suppository 
is first introduced. 

Untoward Effects. — Aside from the results of poisonous doses, a cer- 
tain number of cases taking this drug present slight cyanosis or duski- 
ness of the hands and of the face about the nose and lips; the fingers 
may be cold and clammy, and the feet are often very cold ; sweating is 
a very common symptom of the untoward influence of antipyrin, and 
pricking or tingling of the skin is not uncommonly seen. By far the 
largest number of these cases, however, suffer from disorders associa- 
ated with the skin, and erythematous patches may be seen every- 
where, more particularly on the hands and feet and about the face, 
arms, and chest. Occasionally pemphigus-like spots appear, and 
often large bullae have been noted as present. Elsewhere are pub- 
lished the statistics, collected from medical literature, of 121 cases 



ANTIPYRIN. 95 

of untoward effects exercised by antipyrin. 1 An analysis of these 
shows that females were much more frequently affected than males, 
and that the most susceptible age was decidedly that of full adult life 
- — namely, from thirty to forty years in both sexes. The dose causing 
these effects was most commonly a moderate one — from 10 to 15 
grains (0.60-1.0), or even from 4 to 10 grains (0.25-0.60). This fact 
holds good with regard to both sexes. The time of onset of the symp- 
toms varied somewhat according to whether the drug was given in 
one excessive dose or in frequently-repeated medicinal doses. In 
many instances the appearance of the symptoms was sudden rather 
than gradual. As a rule, the duration of the symptoms did not exceed 
one to three hours, three days being the longest time mentioned. It 
is interesting to note, however, that of all these cases only six proved 
fatal, and in these there was ample cause for death aside from any 
effect of the drug. We can rest assured, therefore, in ordinary cases 
of disease that patients exhibiting untoward effects of antipyrin are 
not in any acute danger, although the symptoms may be temporarily 
most alarming. Typhoid fever seems, according to the statistics 
collected by the writer, to be the disease in which this unexpected 
influence manifests itself most frequently, but this may be due to the 
fact that it is so common a malady and is so frequently treated by 
means of antipyretics. Brunton is responsible for the statement that 
antipyrin is particularly prone to produce collapse in menstruating 
women. Falck has collected a large number of cases of antipyrinism, 
and quotes Pusinelli as having seen vomiting often follow the use of 
this drug. 

Antipyrin very distinctly increases susceptibiliy of patients to taking 
cold, and ought not to be used by those who are forced to go out of 
doors in cold weather. 

Administration. — Owing to the solubility of antipyrin, it is most 
readily given in a little water in a wineglass or spoon. If its slight 
taste is disliked, it may be dissolved in any one of the aromatic waters 
or in syrup of bitter orange-peel or some similar vehicle. Most per- 
sons prefer to take it with water. The amount which may be given at 
a dose is 5 to 20 grains (0.3-1.3), but 3 to 5 grains (0.20-0.3) is the 
best dose in most cases, at least until it is seen how it is borne. 

Incompatibles. — When added to sweet spirit of nitre, antipyrin in 
the course of a few moments produces a blue, changing to a dark- 
green, color, owing to the formation of iso-nitroso-antipyrin, which 
is not poisonous, but when in the form of a dry powder is readily 
oxidized on exposure to slight heat. If this color is not formed, the 
spirit of nitre lacks its nitrous ether, and is worthless, so that we 
have not only another incompatibility to remember, but a new 
means of testing the therapeutic value of all samples of sweet spirit 
of nitre which may be dispensed. Antipyrin is also incompatible 

1 See author's Boylston Prize Essay of Harvard University, on Antipyretics. 



96 DRUGS. 

with the salts of iron, calomel, corrosive sublimate, and carbolic acid. 
With salicylate of sodium it forms a pasty mass; with chloral an oily 
liquid. Beta-naphtol and tannic acid are also incompatible with it. 
Tannic acid and non-alcoholic solutions of tannic acid form an insol- 
uble precipitate with antipyrin, as does also the tincture of iodine. 

ANTITOXIN. 
(See Part III.) 

APIOL. 

Apiol is a camphoraceous body, derived from common parsley 
or Petroselinum. As its melting-point is very low, it cannot be kept in 
solid form, and is always dispensed in 75 per cent, solution. So far as 
is known to the author, no careful study of its physiological action has 
ever been made, but two French observers, Joret and Homolle, state 
that in overdose it causes ringing in the ears, intoxication, and severe 
frontal headache. 

Therapeutics. — Originally introduced to combat malarial fevers, 
because of a fancied resemblance in its toxic action to quinine, 
apiol has found its level as a remedy in amenorrhea, given in the 
dose of 2 to 8 minims (0.1-0.5) three times a day for a week before the 
expected date of menstruation. It should be given, if possible, in 
capsules, owing to its unpleasant taste. It is said not to possess any 
abortifacient influence, although it is often taken with this object in 
view. 

Apiol is imported from France in capsules containing a little less 
than 3 minims (0.20), and is also put up in soft elastic capsules in the 
United States. 

APOCYNUM. 

Apocynum Cannabinum should not be confused with Apocynum 
Androsima? folium, which has few of its properties, but which is often 
employed by mistake for the real drug. When good effects do not 
follow the use of the drug another sample should be tried. The remedy 
in overdose is capable of causing vomiting and purging through gastro- 
intestinal irritation, but in medicinal dose rarely does so. It is employed 
in medicine for the relief of cardiac and renal dropsy of the subacute 
or chronic type, and is best given in the form of the tincture or fluid 
extract in the dose of 5 to 20 minims (0.30-1.3) of the former or 1 to 5 
minims (0.05-0.30) of the latter. Under its influence profuse diuresis 
occurs, and the fluid is removed so rapidly that the drug has been 
called the " vegetable trocar." 

Physiological studies show that the action of the drug on the heart 
is similar to that of digitalis, as it slows the pulse and raises blood- 
pressure, 



APOMORPHINE. 



97 



APOMORPHINE. 

Apomorphine is an artificial alkaloid obtained by the action of hydro- 
chloric acid upon morphine in a sealed tube to which is applied a high 
heat. It is a whitish or gray powder, made up of minute crystals, 
which rapidly undergo decomposition when exposed to the air. The 
drug should be kept in dark bottles well stoppered. A very important 
point to remember is that solutions rapidly decompose, and, if employed, 
may produce poisonous symptoms. The drug ought to be freshly 
dissolved each time it is used. If the salt imparts an emerald-green 
color to 100 parts of water when shaken a few times, it should be 
rejected, unless it is found that the water contains small amounts of 
ammonia, which is supposed to be active in causing such a change. 



Fig. 11. 




A, apomorphine stimulates vomiting centre in the medulla. 

According to Boyer and Guinard, there are two kinds of apomor- 
phine sold. Each has a physiological effect different from that of 
the other. The crystalline form, which is the one always to be em- 
ployed, causes, in overdose, irritation, spasms, trismus, vertigo, and 
hyperesthesia; while the amorphous form (never to be used) .causes 
collapse, hypothermia, general weakness, feebleness of the heart and 
respiration, and anaesthesia. 

Physiological Action. — One of the best studies of this drug is that 
of Reichert, who found that in poisonous doses it produces convulsions, 
and finally paralysis, both of which are chiefly spinal in origin. 

Nervous System. — On the nervous centres in the brain apomor- 
phine acts as a stimulant, but the convulsions produced by poisonous 
doses are probably spinal. The motor and sensory nerves are par- 
alyzed by poisonous doses, and even the muscles become poisoned 
and incapable of contraction. Medicinal doses have no effect, 

7 



98 DRUGS. 

Circulation. — When given in moderate amounts, apomorphine 
increases the rapidity and force of the pulse and raises arterial 
pressure by stimulation of the accelerator nerves and the vasomotor 
centre. In large doses it acts as a circulatory depressant. 

Respiration. — After ordinary amounts no changes in respiration 
occur, but after poisonous doses the breathing becomes rapid and 
irregular. 

Vomiting. — Vomiting is produced by a direct action of the drug 
upon the vomiting centre in the medulla, and not by an action on the 
stomach. Apomorphine is, therefore, a typical centric emetic. 

Therapeutics. — Apomorphine is useful in nearly all cases where an 
emetic may be employed. In poisoning from other drugs, particu- 
larly depressants and narcotics, we have little knowledge of its safety, 
but unless the stupor or circulatory change is very profound, the 
drug may be used with care. In subacute and chronic catarrh of the 
stomach and air-passages it may aid in getting rid of the mucus 
by emesis, and in non-emetic dose it is a useful remedy in acute bron- 
chitis when it is necessary to quiet irritation and relieve excessive 
cough, or when the secretion is very scanty. Non-emetic doses of fa 
grain (0.002) have been used as often as every three hours with 
asserted success in producing nervous quiet in alcoholic excitement and 
delirium tremens. 

Untoward Effects. — Apomorphine rarely causes disagreeable effects, 
but there are cases on record in which it has produced serious symp- 
toms even when given in ordinary doses. These symptoms have con- 
sisted in depression and collapse. One-fifteenth grain is said to 
have caused death in a woman who had bronchitis, but was other- 
wise healthy. Probably in these cases the amorphous form was 
used. 

Administration. — The drug when used as an emetic should always 
be given hypodermically and the solution be freshly prepared. The 
emetic dose is about y 1 -^ grain (0.006), but as much as \ grain (0.012) 
may be used in strong patients. The expectorant dose is fa to fa 
grain (0.0015-0.003) by the mouth. No nausea is usually felt. The 
drug nearly always acts badly in children, and it is better not to 
use it in this class of patients. The salt used is Apomorphine Hydro- 
chloridum, U. S. and B. P. An injection (Injectio Apomorphincp 
Hypodermica) — 1 grain (0.06) dissolved in 100 minims (6.6) of cam- 
phor-water — is official in the B. P. 

ARISTOL. 

(See Thymol Iodide.) 

ARNICA. 

Arnica is derived from Arnica montana, a native plant of the 
Western United States and Europe. It holds a very high position 



ARSENIC. 99 

in domestic medicine as a local and internal remedy in sprains and 
bruises, and in the treatment of passive hemorrhages, amenorrhea, and 
similar states. 

Physiological Action. — When arnica is applied to a delicate skin, 
it produces burning and irritation, and even extensive skin lesions. 
x\ccording to the studies of the author, it slows the pulse, raises the 
blood-pressure slightly, and stimulates the vagus nerves. Toxic doses 
produce a rapid pulse from paralysis of these nerves. 

Administration. — Arnica is rarely given internally. If it is so used, 
the dose of the tincture of the flowers (Tinctura Arnica?, U. S.) is 
15 to 30 minims (1.0-2.0), and the same amount of tincture of the 
root (Tinctura Arnica? Radicis) may be employed. The plaster (Em- 
plastrum Arnica') is very useful in external applications. 

The tincture of arnica is the preparation usually applied to sprains 
and bruises, and the alcohol contained in this preparation accomplishes 
a large part of the good achieved. 

The only British preparation is the tincture (Tinctura Arnica), 
which is given in the dose of 30 minims to 1 drachm (2.0-4.0). 

ARSENIC. 

Arsenic (Arsenum) itself is never employed in medicine, but it is 
used in the form of arsenic trioxide or the arsenate of sodium, potas- 
sium, or copper. When a physician speaks of giving arsenic to a 
patient he usually refers to arsenic trioxide. Arsenic trioxide is con- 
verted into arsenous acid when dissolved in water. 

Arsenic trioxide (Arseni Trioxidum, U. S.; Acidum Arseniosum, 
B. P.) is derived from arsenic- bearing ores by roasting them in a 
reverberatory furnace, when it rises in the form of a vapor which 
adheres to the walls of the furnace, requiring a second sublimation, 
owing to the first deposit being quite impure. It is soluble in water, 
is without odor, and when heated gives off the odor of garlic. 

Physiological Action.— The effects produced in man by poisonous 
doses will be found considered under the heading of Poisoning. 

Applied to the normal skin, arsenous acid produces no change of 
any moment, but if the surface be broken or a wound or sore exist, 
its action is very powerful, and it destroys the tissues to a consid- 
erable extent. For this reason it has been employed as a caustic 
by "quacks" and to some extent by regular physicians, the latter 
using it to remove warts, condylomata, and similar growths, while the 
former have employed it chiefly as a "cancer cure," asserting that it 
would take the disease "out by the roots," which is of course untrue. 

Nervous System. —In medicinal amounts the drug probably acts 
as a stimulant to the trophic nervous apparatus. 

Circulation. — In moderate amounts arsenic has little or no influ- 
ence upon the circulation. Large doses cause marked decrease in 

•' 0$ 



100 DRUGS. 

the force and frequency of the pulse, accompanied by a decided fall 
in arterial pressure, and in these amounts it is to be regarded as a 
distinct cardiac depressant which depresses all the heart's component 
parts, such as the ganglia, muscle, and nerves. The fall of the 
arterial pressure is due to vasomotor depression with relaxation 
of the general bloodvessels, more especially those of the abdominal 
cavity. According to Lesser, small doses cause it to act as a cardiac 
stimulant, increasing the pulse-rate. Arsenic is absorbed by the 
bloodvessels. 

Respiration. — In small amounts arsenic very distinctly stimulates 
the respiratory centre, and Lesser asserts that small doses stimulate 
the peripheral ends of the vagi in the lungs, but that in toxic quan- 
tities arsenic acts as a powerful respiratory depressant. 

Absorption, Elimination, and Retention. — When arsenic in 
any of its soluble forms and in medicinal or moderately poisonous 
dose enters the body by way of the alimentary canal, or through a 
break in the skin, or by way of the lungs, it is speedily absorbed and 
distributed to all parts of the body by the blood and lymph. The 
rapidity of its absorption depends upon the activity of the circulation 
in the part with which it comes in contact, and when it is taken by the 
mouth upon the quality and quantity of the food and drink which 
may be present in the stomach. If these are considerable in amount, 
its absorption is of course delayed, as is also its local effect upon the 
mucous membrane. When brought in contact with the tissues in 
concentrated form, it acts so powerfully that it may destroy them 
and so for a time at least prevent its own absorption because the 
bloodvessels and lymph channels are prevented from carrying their 
normal fluids. 

When the dose is medicinal or slightly toxic, the drug is eliminated 
chiefly by the kidneys, although it escapes to some extent by all the 
secretions, such as the bile, the sweat, the saliva, and even in the milk 
of nursing women, and it may produce in the nursling symptoms of 
gastro-intestinal irritation by this means. The rapidity with which 
it escapes from the body after it is absorbed varies greatly in different 
persons. It does not as a rule appear in the urine very promptly 
after it is taken, and it continues to be eliminated over a long 
period of time in some cases. Thus cases are on record in which 
it was found in this secretion several months after its use had been 
stopped. 

When a large poisonous dose of arsenic is taken by a human being, 
the greater part of it escapes from the body by reason of the vomit- 
ing and purging which it induces. It is possible for these efforts at 
elimination to be so prompt and complete that very little of the poison 
gains access to the general system. A large poisonous dose may there- 
fore be less capable of producing death than one which is smaller in 
amount but nevertheless lethal in its effects. If the drug when taken in 



A BSE NIC. 1()1 

these poisonous doses is absorbed, it escapes, as it does in medicinal 
doses, chiefly by the kidneys, the feces, and by the other secretions 
named, and it is important to recall the fact that the amount of arsenic 
found in the feces does not represent alone that quantity which has 
passed through the alimentary canal unabsorbed, but also that it rep- 
resents some of the poison which has entered the general system, 
because the liver and gastro-intestinal mucous membrane eliminate the 
drug by this pathway. 

During the time the arsenic remains in the body after absorption 
it is deposited chiefly in the liver and in the kidneys, in the walls of 
the stomach and bowels, and even in the muscles and bones. It has 
also been stated that it is deposited in the white matter of the brain 
in quantities which are considerable. When seeking for arsenic in a 
case of suspected death from this cause, it is important to examine 
the bones, because in some instances the drug is found in them in large 
amounts after it is no longer to be found in other organs. It is from 
these "storehouses" of arsenic that eliminating organs obtain their 
daily supply for elimination. Arsenic is so rapidly eliminated in some 
cases of fatal poisoning that only a trace of it can be found on chem- 
ical analysis after death. 

Tissue-waste. — According to Chittenden and Cummins, arsenic 
in medicinal amount distinctly decreases tissue-changes. Large 
doses, however, greatly increase nitrogenous metamorphosis. 

Therapeutics. — Arsenic is used in chorea, in which it is almost a 
specific, acting in an unknown manner. The dose should be increased 
rapidly, as patients soon get accustomed to the drug, and large doses 
are essential to produce a cure in most cases. Cases are on record, 
however, in which the continued use of large medicinal doses has 
developed arsenical neuritis. As a tonic combined with iron it is invalu- 
able in simple anaemia, malarial anaemia, and cachexia. In atony of the 
mucous membrane of the stomach and intestine it is exceedingly useful, 
and in ordinary anaemia and debility, combined with a simple bitter tonic, 
it is invaluable. Arsenic is of value, too, for the improvement of 
depraved mucous membranes of the respiratory tract, particularly in 
those persons who have not true tuberculosis, but phthisical tendencies; 
and in individuals who continually have colds in the head, chest, or 
elsewhere. Arsenic offers the best chance of benefiting cases of per- 
nicious anemia, but how it acts is not known. In leucocyth&mia and 
pseudoleukemia arsenic is again the remedy, and it must be constantly 
given up to the point of intolerance to be of value (Fig. 12) . In the latter 
disease good results have followed its use when intraglandular and intra- 
splenic injections of 4 minims (0.25) of Fowler's solution were used, 
and any case of severe anaemia where the stomach is disordered may 
be treated by giving by the rectum in starch-water three times the 
ordinary dose by the mouth or by its use hypodermieally in the pro- 
portion of 4 parts of water to 1 of Fowler's solution. 



102 



DRUGS. 



In malaria arsenic acts as a prophylactic, as a cure, and as an aid to 
convalescence. When the attacks of intermittent fever occur at long 
intervals arsenic is useful as an antiperiodic, quinine being withheld for 
use during the attack itself. 



Fig. 12. 




A case of typical spleno-medullary leuksemia in which under the effects of arsenic the spleen 
decreased in size more than one-half, as shown in outline, and the white cells dropped from 
342,000 to 32,000. There was a gain in weight of twenty pounds. 



No drug is so universally abused as is arsenic in the treatment of 
skin diseases: it should never be employed in "wet" skin diseases; 
that is, those associated with much proliferation of new cells and the 
exudation of serum. Its field of usefulness is in the dry, scaly skin 
affections. 



ARSENIC. 103 

Where the skin is affected in its lower layers arsenic is useless, and 
should be used only where the epiderm is diseased (Duhring). 

In psoriasis arsenic at first makes the skin more red and seemingly 
worse, but this passes off and the patient gets well. This is important 
to remember, as otherwise the drug may be stopped just when doing 
good. Pemphigus, lichen, and lepra all yield to its influence in many 
instances. 

In the treatment of diabetes and pruritus vulva? the drug is said 
to be of value when given internally. In gouty diabetes the use of 
the carbonate of lithium and the arsenate of sodium is often of great 
service. 

In asthma, particularly where the mucous membranes are at fault, 
arsenic is one of the best remedies that we have, either given internally 
or smoked in arsenic cigarettes, which are to be made as follows: 1 



Py — Belladonnas foliorum 



gr. xcvi (6.4). 



Hyoscyam. foliorum gr. xlv (3.0). 

Stramonii foliorum gr. xlv (3.0). 

Extract, opii gr. iv (0.25). 

Tabaci gr. lxxx (5.3). 

Aquae Oj. (480.0).— M. 

Ft. sol. et adde 

Potassii nitratis gr. clx (10.6). 

Potassii arsenitis gr. cccxx (21.3). — M. 

Bibulous paper is to be wetted with this compound, and after drying is to be 
rolled up and smoked as a cigarette. 

A more simple procedure is to wet bibulous paper in a solution of 
arsenite of potassium of the strength of 15 grains to the ounce, dry it, 
and smoke it in the form of a cigarette. 

In chronic rheumatism arsenic is very valuable in certain cases, but 
often fails to be of service. In chronic coryza, in cancrum oris, severe 
sore throat, and chronic nasal coiarrh it is to be employed internally, 
and in some cases of hay fever undoubtedly affords relief. The use of 
arsenic in all stages of phthisis often gives the most surprising results. 
In gastric cancer and ulcer, given in small amounts frequently repeated, 
arsenic will often do good by relieving the pain and checking the 
vomiting through its tonic influence on the gastric mucous membrane. 
It may be tried in the vomiting oj pregnancy with some chance of suc- 
cess, and is often of value in the vomiting of hand-fed babies who are 
suffering from chronic gastric catarrh. It is also useful in the morning 
vomiting of drunkards. In atonic dyspepsia associated with chronic 
diarrhoea and with a tendency to dysentery arsenous acid is of service, 
and in small amounts it is very valuable in frequently repeated doses 
(tto g ra i n [0.0006] every hour) in all forms of serous diarrhwa. 

For gastric atony or torpidity the following prescription is useful, 
but if irritation of the stomach is present it should not be employed : 

1 Philadelphia Hospital Pharmacopoeia. 



104 DRUGS. 

Iy — Liq. potassii arsenitis f 5ss (2.0). 

Tr. micis vomicae -' 5 j (-4.0) vel f oij (8.0). 

Aquee q. s. ad fgiij (90.0). — M. 

S. — Shake the bottle. Teaspoonful (4.0) t. i. d. in water after meals. 

In old persons whose feet become swollen and hot after prolonged 
standing, and who have shortness of breath on exertion, arsenic does 
good, particularly if the cause be cardiac feebleness, when it increases 
the efficacy of digitalis or strychnine so greatly as to be generally indi- 
cated when these drugs are given. 

Locally applied to warts and other growths of the skin for several 
days in the form of Liquor Arsenicalis (B. P.) or Liquor Acidi Arsenosi 
(U. S.) or of Fowler's solution, it causes the growth to drop off or to 
become loosened. Where the growth is very hard and horny, its 
surface should be softened by the application of liquor potassse 
before the arsenical liquor is applied. The same treatment may be 
used for corns. 

Where large malignant growths with extensive surfaces are to be 
attacked locally, the physician must use arsenic most boldly or not at 
all. The danger of absorption is only escaped when the drug is used so 
freely as to destroy the tissues before they can carry on any absorp- 
tion of the poison. A very large area should not be treated at one time. 
Marsden recommended the use of 1 ounce (30.0) each of arsenous 
acid and powdered gum acacia to 5 drachms (20.0) of water as an 
application to epitheliomatous growths. A less painful application, 
because of the anaesthesia caused by orthoform, is as follows: 

^— Orthoform. 5j (4.0). 

Arseni trioxidi 3j (4.0). 

Alcohol fgv (150.0). 

Aquae destillat f§v (150.0). 



Still another is: 



1$ — Arseni trioxid 



gr. lxxv (5.0). 
gr, lxxv (5.0). 
gr. xxx (2.0). 
mxxx (2.0). 
q. s. 



Pulv. acacias 

Cocain. hydrochloridi 

Glycerin 

Aquae destillat. . 
M. ft. paste. 
S. — Apply locally. 

The Marsden paste should be applied to the thickness of about one- 
quarter of an inch, overlapping the edges of the sore, and then covered 
with patent lint. The application is continued from twenty-four to 
forty-eight hours, and then a poultice is applied and the slough 
removed after from five to ten days. 

Administration. — Children generally bear arsenic better than adults, 
proportionately, but Ringer states that boys bear less than girls. The 
drug should be given before meals if it is designed to act on the stomach 
as a tonic, but in other conditions it should generally be administered 
after meals, as it is apt to irritate the stomach if given in full doses 



ARSENIC. 105 

when this viscus is empty. Whenever a patient is given arsenic, he 
should be cautioned to watch for any puffiness about the eyes, par- 
ticularly in the morning on arising, and for slight laxity and griping 
of the bowels. These are signs that the drug should be stopped for 
a day or more. The swelling under the eyes may spread if the use of 
the drug is persisted in, and finally amount to general anasarca. This 
is due at first to a cellulitis, and afterward to a true effusion. (See 
Untoward Effects.) 

It is important from a medicolegal point of view to bear in mind the 
fact that arsenic is one of those drugs to which it is possible to induce 
tolerance. That is to say, by the prolonged and gradual adminis- 
tration of arsenic in ascending doses individuals can finally take very 
large quantities with apparent impunity. Cases are recorded in which 
as much as 7 grains could be taken at one dose without any evil effects. 

The official preparations are: Arseni Trioxidum, U. S.; Acidum 
Arseniosum, B. P., the dose of which is fa to fa grain (0.0015-0.003) ; 
the solution of the arsenite of potassium (Liquor Potassii Ar senilis, U. S. ; 
Liquor Arsenicalis, B. P.) or Fowler's solution, the dose of which at 
first is from 1 to 5 minims (0.05-0.3) in water; the solution of arsenate 
of sodium (Liquor Sodii Arsenatis, U. S. and B. P.), or Pearson's 
solution, the dose of which is 1 to 5 minims (0.05-0.3); and the solu- 
tion of arsenous acid (Liquor Acidi Arsenosi, U. S.), the dose of which 
is 1 to 5 minims (0.05-0.3). This is more irritating to the stomach 
than the other preparations. The iodide of arsenic enters into Dono- 
van's solution (Liquor Arseni et Hydrargyri Iodidi, U. S. and B. P.), 
the dose of which is 2 to 10 minims (0.1-0.60), well diluted. Iodide 
of arsenic (Arseni Iodidum, U. S. and B. P.) is given in fa grain 
(0.003) doses, and arsenate of sodium (Sodii Arsenas, U.S. and B.P.) in 
the dose of fa to fa grain (0.002-0. 006), and the exsiccated sodium arsen- 
ate (Sodii Arsenas Exsiccatus, U. S) , dose -fa to 2V grain (0.0001-0.003). 
Liquor Arsenici Hydrochloricus is also official in the B. P. 

Untoward Effects. — If arsenic is taken in full dose by a susceptible 
person, it may cause a marked dermatitis, with a sensation of severe 
burning in the skin and sometimes herpes zoster (Fig. 13). Pustu- 
lation may occur, and Falck asserts that an erysipelatous state may 
arise. Almost any form of skin lesion may follow its use internally or 
externally, but nearly all show irritation of the true skin. Even a 
scarlatiniform eruption followed by desquamation may ensue. In 
other cases the mucous membranes become inflamed and coryza may 
develop. (See Administration.) The prolonged use of arsenic, 
according to de Schweinitz, may produce vitreous opacities. 

Acute Poisoning. — The symptoms of acute poisoning by arsenic, 
that is, those following the ingestion of one or more large doses of the 
drug, are chiefly due to its irritating properties, but in part to the effects 
which it exercises upon the general system after it is absorbed. Usually 
within an hour after the poison is swallowed the patient experiences 
abdominal distress, a sense of constriction in the pharynx and oesoph- 
agus, and in a short time suffers from violent abdominal pain with 



106 



DRUGS. 



vomiting and, later, profuse serous diarrhoea. As soon as the bowel 
has been well emptied of its feces this diarrhoea becomes a symptom 
which is to some extent pathognomonic, that is to say, the stools 
become clear and may be like the so-called rice-water stools of cholera, 
containing flakes of mucous membrane floating in serum. These 
stools also appear in antimonial poisoning, but in arsenic they are often 



Fig. 13. 




Herpetic eruption along the course of an intercostal nerve due to the use of 16 drops 
of Fowler's solution three times a day. 



streaked with blood, whereas in antimonial poisoning blood is rarely 
if ever seen. The urinary flow is decreased, and it may be suppressed 
because of three factors: (a) the profuse purging drains the body of 
fluid; (b) the passage of the arsenic through the kidneys produces an 
intense toxic nephritis, and (c) the vomiting prevents the ingestion of 
water. If urine is secreted, it is concentrated and albuminous. 

The general symptoms associated with those just described consist 



ARSENIC. 107 

in pains in the extremities, probably due to the abstraction of fluid by 
the purging, great general depression and collapse, with increasing 
feebleness of the circulation and respiration, and finally death from 
the general intoxication produced by the drug, combined with exhaus- 
tion. As death approaches convulsions or coma may develop. Very 
commonly about the third day, if the patient survives so long, an inter- 
mission in the symptoms appears, which will be followed by a return of 
all the symptoms, so that the physician must not give a favorable 
prognosis. In this symptom (remission) the course of arsenical poison- 
ing resembles phosphorus poisoning and yellow fever. Death gen- 
erally occurs about the fourth or sixth day, and on or about the third 
day a peculiar skin eruption sometimes appears which may be of any 
character. In rare cases sudden pain, collapse, and death may take 
place within twelve hours after the ingestion of the poison, or uncon- 
sciousness or heavy sleep, with entire absence of gastro-intestinal symp- 
toms, ensues, death speedily coming on. Widespread multiple neuritis 
may be brought on if the case survives for several days. 

It is to be remembered that acute arsenical poisoning may resemble 
poisoning by any substance capable of producing intense gastro-intes- 
tinal irritation. The symptoms may also be closely allied to those of 
cholera morbus and Asiatic cholera, while in still others the predomi- 
nance of nervous twitchings and coma may be confusing. 

After death from acute arsenical poisoning certain definite lesions are 
found, which are as follows: The mucous membrane of the stomach and 
bowel is reddened and inflamed, and it may be dotted by areas of hem- 
orrhagic exudate. This is not due, however, solely to a corrosive influ- 
ence of the poison, for arsenic is not, strictly speaking, a corroding drug, 
as are the mineral acids, for example. The epithelial lining of the ali- 
mentary canal is easily slipped off as if corroded, but the actual lesion 
consists in the degenerative changes produced in it and the finer blood- 
vessels by the poison. Filehne has expressed the opinion that the 
epithelium is primarily devitalized by the arsenic and then softened 
and digested by the digestive juices. A typical change always present 
in acute poisoning when the patient lives for any length of time is fatty 
degeneration of all the viscera. 

The exact fatal dose of arsenous acid is unknown because the indi- 
vidual susceptibility and readiness of absorption vary greatly. It is 
generally considered that from one and one-half to two and one-half 
grains is a lethal dose. Smaller amounts than this have, however, 
caused death and much larger ones have been survived. 

Treatment of Acute Poisoning. — In addition to washing out the 
stomach by the stomach-pump, applying external heat and stimulants, 
the ingestion of the proper antidotes should be at once employed, and 
the only ones of any value are the freshly-precipitated hydrated sesqui- 
oxide of iron and magnesia. (See below.) The first is to be prepared 
by the precipitation of iron from one of its fluid preparations by the use 
of an alkali. Ammonia added to the tincture of the chloride of iron is 



108 DRUGS. 

efficacious, but the precipitate has to be repeatedly washed to rid it of 
an excess of this irritant. Magnesia is a better precipitant, because it not 
only precipitates the iron, but is also an antidote itself. Monsel's solu- 
tion and the so-called dialyzed iron may be employed in place of the tinc- 
ture, but Monsel's salt is too irritating. Dialyzed iron is so readily 
precipitated that it needs no alkali, but may be given pure. Magnesia 
is a useful antidote when given alone. 

Under the name Ferri Hydroxidum cum Magnesia the U. S. P. 
recognizes an antidote for arsenic; this is often called the "antidotum 
arsenici." The U. S. P. directs that this antidote should be kept on 
hand for immediate use in the following manner: Mix 10 fluidrachms 
(40.0) of the official solution of the tersulphate of iron (Liquor Ferri 
Tersulphatis) with 4 ounces (120.0) of water, and keep the mixture in 
a well-stoppered bottle. Rub 150 grains (10.0) of magnesium oxide 
with a little water to a smooth and thin mixture; transfer it to a 
bottle capable of holding 33 ounces (1000.0), and fill the bottle with 
water. When the antidote is to be used, add the magnesia solution 
slowly and shake the two fluids until a homogeneous mass results. 
(See Iron, Hydrated Sesquioxide of.) 

After the use of the antidote emetics should be used, opium should 
be administered to allay irritation and pain, and large draughts of 
water be given to flush the kidneys and dilute the poison. In the 
later stages the danger from arsenical poisoning arises from the changes 
produced in vital organs. 

Subacute Poisoning. — When the dose of arsenic has not been large 
enough to produce death rapidly, the symptoms manifested are 
somewhat modified. The vomiting and diarrhoea are less severe, 
but the abdominal tenderness and distress are notable. The kidneys 
are manifestly irritated by the drug, for the urine is scanty, bloody, 
or albuminous. In these cases sufficient time elapses for the secondary 
nervous lesions produced by the drug to result in outbreaks of various 
eruptions on the skin and for localized palsies due to neuritis to ensue. 
The mouth is parched, thirst is excessive, the liver is enlarged and 
tender, and the skin hot and dry. 

Chronic Poisoning. — Arsenic very frequently gains access to the 
body in many remarkable ways. It may be taken in cheap beers 
made from glucose, which in turn has been made with sulphuric acid 
prepared from iron pyrites contaminated by arsenic. In other in- 
stances it is obtained from wall-papers laden with arsenical pigments; 
in still other instances it develops in artisans who handle arsenic in 
large amounts. In rare instances the ingestion of a few large doses 
which usually produce acute poisoning has resulted in subacute or 
chronic poisoning because of slow absorption and rapid elimination. 
Chronic poisoning may ensue by the drug entering by the mouth, 
lungs, or skin. 

The symptoms of chronic arsenical poisoning may for convenience 
be divided into three classes, although they are not so separated in the 



ASAFCETIDA. 109 

patient as a rule, being often interwoven in such a manner as to make 
a diagnosis difficult. In one class we find pigmentation of the skin, 
and nervous symptoms due to inflammations of the nerves, such as 
sharp attacks of pain, tingling in the extremities, patches of anaesthesia, 
and localized loss of motor power. Thus it not infrequently happens 
that there develops paralysis of the extensor muscles of the toes or of 
the peroneal muscles. In other cases the flexors of the foot suffer 
chiefly, while in still others the feet escape and the hands are involved 
in the loss of power. In cases of acute poisoning the paralysis may 
appear as early as the third day, while in other cases it may be delayed 
several weeks. The anaesthetic areas are generally confined to the 
extremities, and extend only to the first or the second joint above. 
Sometimes the multiple neuritis caused by arsenic gives rise to symp- 
toms which resemble those of locomotor ataxia. 

In other cases the manifestations of irritation of the mucous mem- 
branes are the predominant symptoms associated with disturbances in 
the nutrition of the skin, so that eruptions are produced, with falling of 
the hair and the development of cachexia. When the poison is inhaled, 
violent attacks of coryza or of asthma may occur and chronic bron- 
chitis ensue. 

Chronic arsenical poisoning must be differentiated from chronic 
lead poisoning and chronic alcoholism. All three of these states may 
occur simultaneously. From lead poisoning it is to be separated by 
the absence of the blue line on the gums, by the fact that in plumbism 
there is rarely much disturbance of sensation and that the motor palsy 
of lead commonly affects the extensors of the forearm rather than 
the muscles of the leg, as does arsenic. The history of the patient is 
also of great aid in the differentiation. It is also said to be a fact that 
muscular atrophy is more rapid in its progress in arsenic intoxication 
than in that due to lead. In lead poisoning eruptions and discolorations 
of the skin are rare. 

Alcoholic neuritis is to be differentiated by the history and appear- 
ance of the patient, by the absence of disorders in the skin, and by the 
presence of mental deterioration. 

Chronic poisoning is to be treated by withdrawal from the exposure 
and by the use of iodide of potassium to aid in the elimination of the 
arsenic. The special symptoms are to be treated by the application 
of electricity, tonics, out-of-door life, and such measures as will im- 
prove the general condition of the patient. 



ASAFCETIDA. 

Asajcetida, U. S., Asajetida, B. P., is a gum obtained by making an 
incision into the root of Ferula joetida. It occurs in irregular masses 
of a dark-yellow or reddish color, which become still more red if exposed 
to the light and air, Asafcetida in tears is a term applied to the drug 



110 DRUGS. 

when it appears in the shape of drops or pearls, and is a form seldom 
seen. Its odor is penetrating and strong, and resembles that of garlic. 
When taken internally, it causes a sensation of warmth and acts as a 
stimulant and carminative in the alimentary canal. 

Therapeutics. — Asafcetida is used in medicine as a carminative which 
will particularly affect the lower bowel, and is useful in the intestinal 
indigestion of old persons when associated with flatulence, and in the 
flatulent colic of children. In the form of rectal injections it is of value 
for the relief of the tympanites of children and in that of adults during 
typhoid fever and pneumonia. It is also used as a stimulating expec- 
torant in the later stages of bronchitis. In the nervous irritability of 
children it is often of service. 

Administration. — Asafcetida is given in pills of asafcetida (Pilula? 
Asafwtida, U. S.), of which two or three may be taken, each one con- 
taining 3 grains (0.20) ; the emulsion or milk of asafcetida (Emulsum 
Asafatidoe, U. S.), the dose of which is \ to 1 ounce (16.0-30.0); and 
the tincture (Tinctura Asafwtidw, U. S. and B. P.), J to 1 fluidrachm 
(2.0-4.0). The suppositories contain what is equal to 40 drops (2.6) of 
the tincture. The plaster of asafcetida (Emplastrum Asafwtida) is 
used where a mild counterirritant and antispasmodic is needed. When 
intestinal indigestion and flatulence occur in old people, the following 
pill is of service: 

1$ — Ext. nucis vomicae gr. v (0.30). 

Ext, kolae gr. v (0.30). 

Asafcetida? , gr. xl (2.6).— M. 

Ft. in pil. No. xx. 

S. — One night and morning. 

The B. P. preparation, not official in the U. S. P., is Pilula Galbani 
Composita, composed of asafcetida, galbanum, and myrrh; dose 5 to 15 
grains (0.30-1.0). 

ASPIDIUM. 

Aspidium, U. S., Filix-mas, B. P., or Male Fern, the rhizome of Dry- 
opteris Filix-mas (or Aspidium Filix-mas, B. P.), is employed in medi- 
cine as a tseniacide or remedy for the tape-worm, and is a very 
efficient and valuable drug under such circumstances, being, perhaps, 
the most reliable of all the vermifuges except pelletierin. When 
employed, the directions and precautions given in the article on Worms 
must be strictly followed (Part IV.). 

Male fern taken in overdose is capable of producing poisoning, and 
when taken in such a dose causes, according to Quivill, irritation of the 
gastro-intestinal mucous membrane and diarrhoea. If absorbed, it acts 
on the central nervous system and causes paralysis, collapse, and death. 
The form and method by which it is eliminated are unknown. It 
may in overdose cause albuminuria and glycosuria. To give more 
than \\ drachms (6.0) of the oleoresin at a dose is dangerous. 



AZEDARACH. HI 

Administration. — Male fern is rarely, if ever, used at present in its 
crude form, being employed most commonly in the United States in the 
form of the oleoresin (Oleoresina Aspidii, U. S.) ; dose \ to 1 fluidrachm 
(2.0-4.0) in capsule, or as follows: 

1$ — Oleoresin. aspidii, 

Tinet. vanillae . . . aa Tllxlv (3.0). 

Pulv. acacise 5ss (2.0). 

Aq. destillat f§j (30.0).— M. 

S. — Take entire amount after fasting, and follow in two hours by a full dose 
of sulphate of magnesium. 

The dose of the liquid extract (Extractum Filicis Liquidum) of the 
B. P. is 15 minims to 1 fluidrachm (1.0-4.0). 

Katamaya and Okamoto, two Japanese investigators, and Poulssen, 
state that castor and other oils should not be used after filix-mas is 
given, as oils increase the absorption of the active principle, and so 
predispose to the development of poisoning. 

ASPIRIN. 

Aspirin is acetyl-salicylic acid, and occurs in white crystalline needles 
which melt at 135° C. and dissolve in water up to the strength of 1 per 
cent. It is readily dissolved in alkaline fluids. Owing to its chemical 
constitution, aspirin has been recently introduced into medicine as a 
substitute for the ordinary salicylates; and as it is dissolved and 
absorbed in the bowel, as is salol, it is said not to irritate the stomach. 
Unless well diluted, however, it causes gastric distress. It is also 
not so disagreeable to the taste as are most of the salicylate prepara- 
tions, and it is claimed is less likely to cause tinnitus. The dose of 
aspirin as a remedy for acute rheumatism is 10 to 15 grains (0.60-1.0) 
three times a day or oftener. It may also be employed as an intestinal 
antiseptic. Aspirin may be given in capsule or in pill-form. Some- 
times it is given in syrup of acacia and water, the mixture being well 
stirred or shaken before the dose is poured from the bottle. 



AZEDARACH. 

Azedarach is the bark of Melia Azedarach, or Pride of China, as it 
is sometimes called. It is found in Syria, Persia, the north of India, 
and in the Southern United States. 

The berries have but little toxic power, and children may eat of them 
largely without ill effect, but the bark is poisonous when taken in over- 
dose, and produces symptoms resembling those of poisoning by spigelia 
or belladonna. It is employed as a remedy for the round-worm, and 
should be given in decoction made by boiling 2 ounces (60.0) of the 
bark in 1J pints (720 c.c.) of water until only a pint (480 c.c.) of 
liquid remains. Of this, from 1 to 2 tablespoonfuls (16.0-30.0) are 



112 DRUGS. 

to be given a child, and repeated every two hours until the bowels are 
opened. It has also been used as a fluid extract prepared by the ordi- 
nary means with alcohol, to which some white sugar should be added. 
The dose of this extract is a teaspoonful (4.0), and it is not to be 
repeated. The decoction is the best form in which to use the drug. 

BARIUM CHLORIDE. 

Barium chloride slows the heart very greatly, steadies its rhythm, and 
at the same time increases the volume of blood thrown out of the ven- 
tricle. It also increases blood-pressure, and Robert has, from a series 
of experiments, concluded that it brings about this change by an 
action on the muscular coats of the bloodvessels. 

If large doses are used in the lower animals, the heart suffers systolic 
arrest from overstimulation, and the strongest irritation of the vagus 
nerves fails to relax the systolic contraction. Still more interesting is 
the statement that this failure of the vagi to inhibit the heart is not the 
result of paralysis of these nerves, but is simply due to the excess of 
cardiac contractile power. The slowing of the pulse is not due to 
inhibitory influence, but depends solely upon the stimulation of the 
heart-muscle, although it would seem probable that the vasomotor 
stimulation, by increasing the arterial resistance, may be at least a 
factor in the reduction of the pulse-rate. 

In most works on chemistry barium is stated to be an irritant poison, 
but to produce such evidences of its presence the dose given must be 
extremely large, and many times greater than any amount useful for 
medicinal purposes. 

Therapeutics. — Barium chloride may be used in all forms of cardiac 
disease in which failure of the heart-muscle is present. In the treat- 
ment of varicose veins it is said to be of value, both when given inter- 
nally and applied locally over the distended vessels. 

A point worthy of remark is the character of the pulse-wave pro- 
duced. While its volume is increased, it does not give that sensation of 
tenseness to the finger that does the pulse produced by digitalis., and 
the pulse-wave seems to be very considerably prolonged — a fact that 
the sphygmograph also records. 

Administration. — The solution of barium chloride to be used inter- 
nally should have the strength of 5 grains to the ounce (0.30-30.0) of 
water, and of this 1 or 2 drachms (4.0-8.0) are to be given three times a 
day. 

BELLADONNA. 

Belladonna is botanically known as Atropa Belladonna, and is official 
in the form of the root (Belladonna? Radix, U. S. and B. P.) and leaves 
{Belladonna? Folia, U. S. and B. P.). Its popular name is "deadly 
nightshade." The drug belongs to a very large class of plants, namely,, 
the Solanacea>, all of which have a similar physiological action. Bella- 



BELLADONNA. 113 

donna contains an active principle in the form of an alkaloid known as 
atropine (Atropina, U. S. and B. P.), which is insoluble in water. The 
sulphate of atropine (Atropine Sulphas, U. S. and B. P.) is soluble, 
and is the salt commonly used. 

Physiological Effects. — In man, full medicinal doses produce flush- 
ing of the face, redness and dryness of the fauces, dilated pupils, some- 
times an erythematous rash over the skin, rarely diplopia and delirium. 
If the dose be still larger, the delirium becomes marked, and is 
wild and talkative. The pulse is rapid and wiry. The rash which 
appears resembles that of scarlet fever, but lacks the punctations. 
The skin may desquamate after the lapse of several days if the rash 
is severe. 

In children belladonna is usually borne very well. When the action of 
belladonna asserts itself in children and in susceptible adults the respira- 
tion is quickened, the eyes become bright and the cheeks red, but lines 
of pallor reach from the malar bones to the angles of the mouth, giving 
to the face a curious expression. 

Absorption. — This drug is very rapidly absorbed. 

Nervous System. — Belladonna when given in medicinal amount 
approaching the toxic dose acts as a powerful excitant of the brain, 
producing talkative delirium. Locally applied, it depresses the periph- 
eral sensory nerves. 

When very large doses are given to animals, paralysis of the spinal 
cord comes on, followed by tetanic spasms, and finally by recovery. 
The primary loss of power is due to paralysis of the entire cord, and the 
second state, of convulsions, to the escape of the motor and sensory 
pathways from the paralysis before the inhibitory centres recover. As a 
result, any peripheral irritation causes violent explosions of motor 
power. 1 Even in large medicinal dose belladonna may be considered 
as a depressant to the motor nerves and as a quieter to sensory nerve- 
filaments. On voluntary muscles the drug has no effect, but upon 
unstriped muscles it acts as a sedative and antispasmodic. It dis- 
tinctly lessens reflex action. 

Circulation. — Belladonna quickens the pulse by depression of the 
peripheral vagi and by stimulating the cardiac muscle and the acceler- 
ator nerves. It produces a rise of arterial pressure by stimulating the 
vasomotor centre and by the increased heart-action which it causes. In 
poisonous doses it causes a fall of arterial pressure due to centric vaso- 
motor palsy, and depression of the muscular coats of the bloodvessels, 
but not to cardiac depression, as has been generally taught, for Reichert 
has proved that the drug is not a heart-depressant unless the dose is 
simply overwhelming. Sometimes when belladonna is given the pulse 

1 If a homely simile, found useful by the writer in teaching, may be used, the inhibitory 
centres may be represented by a schoolmaster and the motor and sensory centres by two boys. 
The escape of chloroform in the room paralyzes them all, but, finally, the boys recover before 
their master and go off as truants (convulsions); at last the master (inhibitory centres) recovers, 
and order, or health, is restored, 



114 



DRUGS. 



becomes slow, but in these cases the slowing is due to temporary 
stimulation of the peripheral vagi or to momentary depression of the 
cardiac motor ganglia. (See Figs. 14 and 15.) 

Respiration. — Atropine is a stimulant to the respiratory centre 
in ordinary amounts, but recent careful studies show that its high 
reputation as a respiratory stimulant is not based either on clinical 
or experimental evidence. In many cases it fails to increase the 
respiration at all, and it is certainly inferior to caffeine and strych- 
nine in the treatment of opium poisoning. In large doses it is a 
depressant and paralyzant to respiration, and produces death from 
respiratory failure due to paralysis of the motor nerves supplying 
the respiratory muscles, and probably by depressing the respiratory 
centres. 

Fig. 14. 




A, atropine depresses the peripheral vagi and stimulates the accelerator nerves C. It raises 
arterial pressure by stimulating the vasomotor centre B. 



Abdominal Viscera. — Belladonna increases peristalsis by depress- 
ing the peripheral ends of the inhibitory fibres of the splanchnic 
nerves, and by diminishing any tendency to spasm on the part of the 
muscular coats of the intestine. 

Action on Secretion. — The drug decreases all the secretions of 
the body except the urine, which is sometimes increased in amount 
under its use. The decrease of secretion is due to paralysis of the 
peripheral nerve-filaments supplying the secretory cells of the 
glands. 

Bodily Heat. — When belladonna is used in large amounts there 
is nearly always a rise of temperature, which in children may amount 
to one or two degrees. In advanced poisoning the temperature rapidly 
falls. 

Elimination. — Atropine is eliminated by the kidneys and bowels 
with extraordinary rapidity, and this is one of the reasons why death 



BELLADONNA. 115 

from poisonous doses of the drug is so rare. J. Harley asserts that it is 
entirely eliminated in two hours, and Meuriot states that not a trace of 
it can be found after twenty-four hours, and that it is partly destroyed 
in the liver. In a case of suspected poisoning the urine of the patient 
may be dropped into the eye of an animal, when, if atropine or 
belladonna has been taken, mydriasis will result. 

Eye. — On the eye belladonna produces dilatation of the pupil in 
part by a depressant action on the endings of the oculomotor nerve in 
the iris, by causing a paralysis of the muscle fibre in the iris and per- 
haps by a stimulant effect on the peripheral sympathetic nerve-fibres. 
The dominant action of the drug is undoubtedly the depression of 
the circular muscular fibres of the iris. Associated with mydriasis 
there is also paralysis of accommodation due to the paralysis of the 
ciliary muscle by the effect of the drug on the oculomotor nerve. 
Belladonna generally increases intraocular tension. 

Poisoning. — Poisoning by atropine is an exceedingly common occur- 
rence, but death is rarely produced by it, partly because its influence 
is not very actively exercised on vital parts, and partly because it is 
eliminated by the kidneys almost as rapidly as it is absorbed from the 
stomach. Recovery has occurred after as much as one grain of atro- 
pine has been taken by a child of three years. Aside from the symp- 
toms of mild poisoning detailed under the heading of physiological 
action, severe poisoning is characterized by deep sleep, preceded, it 
may be, by convulsions, violent delirium, blindness, and sometimes 
loss of speech. 

Treatment of Poisoning. — Poisoning by belladonna is to be 
treated by emetics, the application of external heat if the patient passes 
into collapse, and the use of strychnine if respiration fails. Opium 
may be employed in carefully graded doses as the physiological antag- 
onist; but large doses are of doubtful service, particularly if the respi- 
rations are not in a satisfactory state. 

Therapeutics. — Belladonna is used to allay -excessive secretion, to act 
as an antispasmodic, and to influence the circulatory apparatus when 
local inflammations are beginning, particularly in secretory glands, 
and to act as a vasomotor stimulant (Fig. 15). In cardiac palpitation 
small doses of belladonna internally, or its external use over the praecor- 
dium in the form of the plaster or ointment, is very valuable. It is the 
most useful vasomotor stimulant in collapse. 

For the relief of local nerve-pains it is of value, and probably acts 
by quieting the irritated nerve. It should be applied in these cases in 
the form of an ointment or plaster, and if the ointment is used it should 
be well rubbed into the part affected. 

To check secretion in night-sweats it is one of the most powerful 
remedies we have, and it is useful in excessive idiopathic ptyalism, as 
seen in children, or in that due to mercurialization. In bromidrosis 
of the feet and other localized sweatings it is useful, and may be 
employed locally or taken internally for their cure. It is the most 



116 DRUGS. 

efficacious drug we have for checking the secretion of milk in an inflamed 
breast, and under these circumstances it is to be smeared over the 
gland in an ointment. Belladonna may be used in serous diarrhoea, 
as it checks the disorder by stimulation of the splanchnic vasomotor 
filaments of the intestinal bloodvessels, which being inactive permit 
a transudation of liquid into the bowel. 

Trousseau recommended as a local remedy 1 to 2 grains (0.06-0.12) 
of the extract of belladonna with 6 to 8 grains (0.40-0.50) of tannic 
acid in leucorrhoea dependent upon disease of the uterine cervix. This 
should be placed on a pledget of cotton and applied to the affected 
part daily, being allowed to remain all day. Ringer states that if 
pain is also present in these cases the following injection is of value : 

1^ — Sodii bicarbonatis ^j (4.0). 

Tr. belladonna? f sjiij (12.0). 

Aquas dest q. s. ad Oj (480 c.c.).— M. 

This is to be injected into the vagina, the woman first being placed on 
the back with the buttocks raised, so that the drug may bathe the 
uterine cervix for some minutes. 

As an antispasmodic, atropine is to be used in acute torticollis, in- 
jected directly into the muscle itself, so as to act on its motor nerve- 
fibres; it may be given in spasm of the intestine with cramps and 
griping. In cramps in the legs and body, either as a local application 
by means of liniments or when employed internally, it is of service. 
In asthma of the spasmodic type belladonna is a sovereign remedy, 
particularly if it be combined with morphine. It may be used both 
as a prophylactic and as a cure during the attack. Belladonna-leaves 
may be smoked by asthmatics by rolling them into a cigarette or put- 
ting them into a pipe. 

This drug is used in whooping-cough at all ages and in all stages, 
but it must be given in large amounts in this disease to be efficacious. 

In spasm of the sphincter ani, whether it be due to fissure or other 
cause, belladonna in the form of an ointment or suppository is of value. 
In spasm of the urethra and bladder the drug may be used internally 
and externally, and in the former state the ointment should be smeared 
along the under surface of the penis every night. This treatment is 
also useful in chordee. In the colic resulting from the passage of 
hepatic and renal calculi belladonna in full dose will very often give 
relief. Where urinary incontinence depends upon spasm of the bladder 
belladonna should be used. (See Incontinence of Urine.) In dys- 
menorrhea in nervous women, with spasm of the cervix uteri, it is of 
great value applied as an ointment or in a vaginal suppository, or 
when given by the mouth. For the nervous cough of children and 
adults belladonna is one of the best remedies we have. In constipa- 
tion it does good by depressing the inhibitory nerves of the intestine. 
It is also of value in laryngismus stridulus and in hiccough. In spasms 
from peripheral irritations belladonna is useful. 



BELLADONNA. 



IV 



In iritis atropine is used to dilate the pupil and prevent adhesions. 
The solution to be dropped into the eye should contain 1 to 4 grains 
(0.06-0.25) of atropine sulphate to the ounce (30.0) of water. (See 
Iritis.) Atropine sulphate is also used for the purpose of producing 
mydriasis before ophthalmoscopic examination, in solutions of the 
strength just given. It increases intraocular tension and is contra- 
indicated in glaucoma. 



Fig. 15. 



\j\fWVi\^^ 



II 



III 




IV 



Tracing showing the effect of atropine as a vasomotor stimulant (after Schmiedeberg) : I. 
Normal tracing of pressure (126) and pulse 28 in 10 seconds. II. Pressure lowered by pilocar- 
pine to 96, pulse 19. III. Tracing continued, pressure 70. IV. Atropine has been given, raising 
the pressure to 145, pulse 30 in 10 seconds. 



When employed to act on the circulation, it is to be used in shock 
and collapse from injury or in the course of severe disease. (See 
Shock.) During the progress of a case of pneumonia, typhoid fever, 
or other severe disease belladonna should be kept in the house, and 
administered freely if collapse or vasomotor relaxation suddenly asserts 
itself. Particularly is this true in the case of pneumonia. The vas- 
cular system after the crisis of this disease will often be found much 
relaxed, and heart stimulants do not seem to do much good. The 
administration of atropine or belladonna will dry the leaking skin, 
and by increasing the vasomotor tone produce great improvement. 



118 DRUGS. 

In mastitis, or inflammation of the breast, even where pus is beginning 
to be formed, belladonna, if pushed, will give surprisingly good results 
if given internally and applied locally. In acute sore throat, when there 
is a sensation of rawness in the pharynx, while the local capillaries 
appear injected and red, belladonna is often of the greatest service if 
given in full dose, aborting the "cold." 

In exophthalmic goitre belladonna is thought to act by stimulating 
the sympathetic nerves, and certainly gives relief in some cases, par- 
ticularly if combined with stro'phanthus or digitalis. 

In headache occurring in young persons, often due to ocular over- 
work, with pain in the eyeballs and forehead and a sensation as if the 
orbits were too small for the eyeballs, belladonna is of service. In 
intercostal neuralgia or pleurodynia belladonna plasters may be applied 
to the spot where the pain is felt, with relief. 

Use of Atropine in Poisoning. — xltropine is a physiological antidote 
to opium, Calabar bean or physostigma, and jaborandi. In opium 
poisoning it acts as an antidote in all parts of the body except the eye, 
and in jaborandi poisoning the same holds true; but in the former 
condition, although it has been largely used, it is no longer regarded 
as a satisfactory antidote; and caffeine and strychnine are preferable. 
The condition of the pupil is not a guide as to the effect of atropine 
in opium poisoning, because opium acts centrically and atropine acts 
peripherally on the nerves governing the iris. Atropine should be 
used in aconite, antimony, and hydrocyanic acid poisoning for its 
stimulating influence on the vasomotor system, the respiratory centre, 
and the heart, and for the purpose of maintaining the bodily heat, the 
dissipation of which it retards by preventing vasomotor palsy and 
consequent dilatation of the peripheral bloodvessels. 

Atropine is a valuable physiological antidote to poisonous mush- 
rooms, particularly the Amanita, as it is antagonistic to their poison, 
muscarine. The dose given should be large, and, if need be, repeated. 

Administration. — The dose of the sulphate of atropine (Atropine 
Sulphas, U. S. and B. P.) is ^ihr to to g rain (0.0004-0.0015). The 
alcoholic extract (Extractum Belladonna? Foliorum, U. S.) is given in 
¥ t° i grain (0.01-0.015) doses, and the tincture (Tinctura Belladonna? 
Foliorum, U. S. ; Tinctura Belladonna?, B. P.) in the dose of 5 to 15 
minims (0.3-1.0). Both these preparations are derived from the 
leaves. The fluid extract (Fluidextr actum Belladonna Radicis, U. S.) 
is given in 1- to 2-minim (0.05-0.10) doses, while the extract (Extrac- 
tum Belladonna? Liquidum) of the B. P. is given in J- to 1 -minim 
(0.015-0.05) doses. These preparations are derived from the root. 
Belladonna liniment (Linimentum Belladonna?, U. S. and B. P.), 
belladonna plaster (Emplastrum Belladonna?, U. S. and B. P.), 
the ointment (Unguentum Belladonna, U. S. and B. P.), and 
the oleate of atropine (Oleatum Atropine), are for external appli- 
cation. The preparations of the B. P. not official in the U. S. P. 
are Liquor Atropines Sulphatis, dropped in the eyes in the dose 
of J to 1 minim (0.025-0.05) ; Lamella? Atropines, each of which 



BENZOIN AND BENZOIC ACID. 119 

contains ^oVo" g ra <i n of atropine; and Unguentum Atropitiw and 
Extractum Belladonna? Alcoholicum, derived from the root. Succus 
Belladonna?, B. P,, is given in 5- to 15-minim (0.3-1.0) doses. There 
are also a green extract of belladonna, official in the B. P. under the 
name of Extractum Belladonnas Viride, and a suppository (Supposi- 
toria Belladonnas) which contains lj grains of the extract. 

Contraindications. — Recent experiments show that belladonna 
decreases gastric secretion very considerably in some persons. It is 
better, therefore, not to administer it just before or immediately after 
a meal, unless it is desired to reduce this secretion. 

BENZOIN AND BENZOIC ACID. 

Benzoin (Benzoinum, U. S. and B. P.) is a resinous balsam derived 
from Styrax Benzoin, which is a native of Sumatra, Borneo, and 
Java. Benzoic acid is obtained by the sublimation of gum benzoin, 
or is prepared artificially, chiefly from toluol. The last method of 
preparation is not to be recommended, as the acid so made often dis- 
orders the stomach and leaves a disagreeable taste in the mouth. It 
is benzoic acid which is generally used in medicine. 

Physiological Action. — Locally applied in concentrated form, ben- 
zoic acid is an irritant, and taken internally in excessive amount it 
causes a sensation of warmth and burning. It is eliminated as hippuric 
acid and increases the acidity of the urine. It is an antiseptic and 
germicide. In persons having an idiosyncrasy to benzoic acid it is 
not uncommon for urticaria to follow the use of the drug. Sometimes 
a papular or erythematous eruption appears. 

Therapeutics. — Benzoic acid is useful in the treatment of chronic 
cystitis with alkaline urine which is loaded with phosphates, and, 
combined with cannabis indica, acts well in the later stages of gonor- 
rhea. Senator states that in the dose of 2 or 3 drachms (8.0-12.0) a 
day it is a specific in acute rheumatism, and thinks it equal to salicylic 
acid. When these doses are to be used, the benzoate of sodium should 
be employed, owing to its solubility. In acute laryngitis accompanied 
by great hoarseness the inhalation of steam laden with compound 
tincture of benzoin is of the greatest service. A tablespoonful (15.0) 
of this tincture should be placed in a pitcher of boiling water, the face 
held over the liquid, and a towel thrown over the head of the patient 
to retain the steam. The drug cannot be used in an atomizer, as it 
clogs the ''tips." Taken internally, benzoic acid is useful as an 
expectorant in chronic bronchitis in the dose of 10 grains (0.60) three 
times a day. 

Administration. — The dose of benzoic acid (Acidum Benzoicum, 
U. S. and B. P.) is usually 10 to 40 grains (0.6-2.6), but a drachm 
may be given in capsule. The gum itself is never used as such. The 
tincture (Tinctura Benzoini, U. S.) is given in 30-minim to 1-drachm 
(2.0-4.0) doses, and the compound tincture (Tinctura Benzoini Com- 



120 DRUGS. 

posita, U. S. and B. P.) is composed of benzoin, aloes, storax, balsam 
of Tolu, and alcohol, the dose of it being 1 to 2 fluidrachms (4.0-8.0). 
The preparations official in the B. P., but not in the U. S. P., are 
the troche (Trochiscus Acidi Benzoici) and Unguentum Cetacei. 

Adeps Benzoinatus (U. S.) and Benzoatus (B. P.), or benzoated 
lard, is a non-rancid basis for many ointments, notably that of zinc. 

BISMUTH. 

Bismuth is official as the subcarbonate (Bismuthi Subcarbonas, 
U. S.), the subnitrate (Bismuthi Subnitras, U. S. and B. P.), the 
citrate (Bismuthi Citras, U. S.), the bismuth and ammonium citrate 
(Bismuthi et Ammonii Citras, U. S.), the bismuth subgallate (Bis- 
muthi Subgallas, U. S.)> and the bismuth subsalicylate (Bismuth Sub- 
salicylas, U. S.). The first and second are identical in their dose (5 
to 20 grains — 0.3-1.3) and action, and may be employed interchange- 
ably. The third and fourth are more astringent and more irritating 
than the others, and must be given in a smaller dose, which is 2 to 4 
grains (0.12-0.25). 

Formerly this drug was supposed to be capable of producing 
gastro-enteritis when given in large doses, but this was due to con- 
tamination by arsenic. Bismuth may produce chronic poisoning after 
prolonged use on wounds or when internally administered in excessive 
doses for some time. Ordinary doses are innocuous. As much as 4 
to 5 drachms a day may be given for a short time without harm. The 
changes which ensue when the drug is abused are the formation of 
black sloughs in the mouth and gastro-intestinal tract, desquamative 
nephritis, and albuminuria. The preparations of the B. P. not official 
in the U. S. P. are Liquor Bismuthi et Ammonii Citratis, dose J to 
1 fluidrachm (2.0-4.0), and the troche (Trochiscus Bismuthi Com- 
positus), 2 grains (0.12) in each. Bismuthi Carbonas, B. P., is the 
same as the subcarbonate of the U. S. P. Bismuthi Oxidum, B. P., 
is given in the dose of 5 to 20 grains (0.3-1.3). 

Physiological Action. — Bismuth in the form of the subnitrate 
and subcarbonate is devoid of effect upon the general system, and 
locally applied externally, or when given internally, exercises a mild 
astringent and protective influence upon mucous membranes, 

Therapeutics. — Bismuth is used as a mild astringent in large doses 
to cover the surface of inflamed mucous membranes and so to allay irri- 
tation. It is useful in irritative vomiting for this reason, and in diar- 
rhea of a similar type in which the stools are serous. If the passages 
are mucous, castor oil should precede bismuth in order to rid the ali- 
mentary canal of the mucous secretion already poured out. It is very 
useful when combined with carbolic acid in serous diarrh&a, given in 
capsules containing 10 grains (0.60) of bismuth subnitrate and 1 minim 
(0.05) of carbolic acid. It may also be used as a slowly acting and 
feeble antacid. Bismuthi et Ammonii Citras is very astringent, and 
should be used in chronic serous diarrheas in the dose of 5 grains (0.3) 
every two or three hours. The other preparations of bismuth are 



BISMUTH. 121 

insoluble, and they should not be given in water, but this preparation 
is soluble and may be given in solution. Bismuth is of service in 
dyspepsia when lactic- and butyric-acid fermentation is present with 
excessive belching, and may be employed in gastralgia and gastric 
ulcer and gastritis as a sedative and astringent. Bismuth and ammo- 
nium citrate should never be employed if acute inflammation exists. 

When the salts of bismuth are used for any length of time, they 
cause the odor of garlic in the breath, which is due to the presence 
of an exceedingly slight trace of tellurium in the bismuth. The 
stools are apt to become black under the influence of bismuth, and 
the tongue, if furred, may also be black about the centre when bismuth 
is used. 

Where there is chapping of the hands or cheeks from exposure to 
cold or wet the following prescription is useful: 

1$ — Bismuthi subnitratis 3iij (12.0). 

Zinci oleatis 5iij (12.0). 

Lycopodii §ij (8.0).— M. 

S. — Apply to the parts t. i. d. 

Bismuth Benzoate. 

This is a preparation which has been highly recommended in Ger- 
many, and to some extent in the United States, within the last few years, 
in the treatment of chancroid. Under its influence the sore heals 
with great rapidity and leaves a comparatively small cicatrix. It may 
also be used in the treatment of all specific sores and for the dressing 
of indolent or sloughing ulcers. Benzoate of bismuth, when properly 
applied, should be preceded by a careful washing of the diseased sur- 
face with a very weak bichloride-of -mercury solution, after which the 
bismuth is to be sprinkled over the wound and the entire surface cov- 
ered with cotton, which should be held in place by an adhesive strip. 
The only disadvantage of this dressing lies in the fact that it has to 
be changed once or twice in every twenty-four hours. Immediately 
after it is applied it may produce tingling or burning, but this is 
never severe. 

Bismuth Subsalicylate. 

Subsalicylate of Bismuth (Bismuthi Subsalicylas , U. S., and Bis- 
muthi Salicylas, B. P.) is a white, soft powder, insoluble in water, 
alcohol, ether, and chloroform, but soluble in acids. It is largely used 
by some practitioners as an intestinal antiseptic in cases in which there 
is diarrhoea due to fermentation or putrefaction. It may be given 
in powder, or, better still, in capsule, in the dose of 3 to 15 grains 
(0.20-1.0). 

Bismuth Subgallate. 

Dermatol, or the subgallate of bismuth (Bismuthi Subgallas, U. S.), 
is a fine yellow powder which is unaffected by prolonged exposure to 
light and air, is odorless, and is supposed to contain 55 per cent, of 



122 DRUGS. 

oxide of bismuth. Its external uses are identical with those of iodo- 
form, and it probably acts in much the same manner as does the latter 
drug — namely, by so drying the wound that it becomes an unfavorable 
site for the growth of germs. As dermatol is an astringent, it cannot 
be employed in the treatment of indolent ulcers, which need stimulation 
rather than an astringent influence, and it would seem probable on 
theoretical grounds that it is not to be compared to iodoform in the 
treatment of cases in which tubercular processes are active. 

There is no doubt that dermatol is less poisonous than iodoform, 
but it must be capable of producing some untoward effects if used 
freely for any length of time, since poisoning follows the prolonged em- 
ployment of other bismuth preparations, as has been determined by 
Balzer, Dalche, and Villejean, for the symptoms of which see the article 
on Bismuth. 

Dermatol may be tried in cases of skin disease in which there is 
much secretion, as in weeping eczemas and similar states, either in the 
form of a dusting-powder or in an ointment with vaseline or lanolin 
in the proportion of \ to 1 drachm to the ounce (2.0-4.0 : 30.0). Some- 
times its efficiency can be much increased by the addition of a drachm 
(4.0) of oxide of zinc to the prescription just given. 

Dermatol has been used with marked success in cases of purulent 
otitis media as a dusting-powder, and in other states requiring similar 
drying and astringent effects. 

Internally, it has been highly recommended in cases of fermentative 
dyspepsia in the dose of 5 to 10 grains (0.3-0.60), but its real value in 
this condition is as yet undetermined. 

BITARTRATE OF POTASSIUM. 

Potassii Bitartras, U. S., Potassii Tartras Acidus, B. P., is some- 
times called " cream of tartar" or acid tartrate of potassium. It is a 
white gritty powder which may occur in rhombic crystals. Owing to 
its stability, it has been thought that it escapes from the body without 
oxidation, and so to differ from the other potassium salts formed by 
vegetable acids. 

Therapeutics. — The bitartrate of potassium is the most diuretic of 
the potassium salts, and is used in chronic nephritis with gin or com- 
pound infusion of juniper, for the purpose of removing dropsy. 1 ounce 
(30.0) of the salt is added to a pint (480 c.c.) of the infusion of juniper- 
berries, and the entire quantity taken in divided doses in twenty-four 
hours. In acute renal disease the drug should be used without the 
juniper. In large doses — J ounce (15.0) — it acts as a watery purge, 
but is rarely so used. Where the urine is thick and alkaline, bitartrate 
of potassium is a useful remedy to neutralize it and make it clear and 
normal in appearance. 



BOM AX AND BORIC ACID. 123 

BORAX AND BORIC ACID. 

Borax (B. P.), or Sodii Boras, U. S., may be made by the action of 
boracic or boric acid upon soda, but the drug as it appears in commerce 
in America is derived entirely from natural deposits found on the shores 
of lakes in California and Nevada. The natural product has to be 
purified before it is marketable. Borax is soluble in twelve times its 
weight of water. Both borax and boric acid have been supposed to act 
as efficient germicides in strong solutions, but this has been proved 
incorrect. They are antiseptics, however, even in weak solutions. 
Upon the body borax has little effect in any dose which is given for a 
medicinal effect. It is rapidly eliminated and renders the urine alka- 
line, and it is too rapidly absorbed from the alimentary canal to permit 
it to act as an intestinal antiseptic. Boric acid exercises even less effect 
upon the system than borax. 

In the form of a lotion boric acid has been used with some success as 
a remedy for erysipelas, and it may be similarly employed in burns and 
scalds. Borax may also be used as a gargle in diphtheria and in aph- 
thous stomatitis, cancrum oris, and gangrenous stomatitis. In the treat- 
ment of pruritus ani and vulva" and in bromidrosis and jetid sweating 
it is of great value when used as a wash. Strong solutions, locally 
applied, are useful in tinea tonsurans and tinea circinata. 

Borax has been used very largely in the treatment of epilepsy, with 
asserted success in some cases. Its employment is purely empirical. 
The dose used is from 8 to 15 grains (0.5-1.0), gradually increased until 
it produces disturbance in the alimentary canal. As the taste is very 
disagreeable to most persons, the drug should be used with liquorice, 
strong coffee, or syrup of bitter orange : 

K — Sodii boratis ^ss (16.0). 

Glycerin f§H30.0). 

Fluidext. glycyrrhiz f M i j (60.0). 

Aquae dest q. s. ad fgvj (180.0).— M. 

S. — Dessertspoonful (8.0) in water after each meal. 

If larger doses than 15 to 30 grains (1.0-2.0) a day are continued 
after the convulsions are decreased in number, there are two difficulties : 
first, that the good effect is rapidly lost; and, second, that untoward 
symptoms, such as nausea and diarrhoea, with emaciation and the 
formation of a scarlatinal, eczematous, or papular eruption, appear. 
A peculiarity of the last two eruptions is that they are distributed 
around the joints. 

Borax should not be used with glycerin, as an acid reaction is apt to 
occur. 

A very useful wash for oral and nasal mucous membranes is " DobelPs 
solution," which is composed of — 

& — Sodii boratis, 

Sodii bicarbonatis aa ^j (4.0). 

Phenol gr. xxx (2.0). 

Glycerini f jfj (30.0). 

Aquse parse Oij (960 c.c). — M. 



124 DRUGS. 

Boric acid (Acidum Boricwn, U. S. and B. P.) is one of the most 
commonly used substances in eye-washes, either alone or with cocaine. 
When used with cocaine or other drugs it is employed to prevent the 
destruction of the alkaloid or glucoside, as the case may be, by the 
growth of mould. The following formula may be employed : 

1$ — Cocain. hydrochlor gr. iv vel viij (0.25-0.5). 

Acid, boric gr. x vel xx (0.65-1.3). 

Aqme dest fgij (60.0).— M. 

S. — To be used by dropping into the eye. 

The official ointment (JJnguentum Acidi Borici, U. S.) or the follow- 
ing makes a very useful application for the skin of the face and hands 
to prevent chapping: 

B— Acid, boric. 3J (4.0). 

Cerae albse gj (4.0). 

Paraffini 31J (8.0). 

01. amygdala 1 express f^ij (8.0). — M. 

S. — To be thoroughly mixed and applied night and morning. 

Boric acid may be given internally in cystitis to render the urine acid, 
and is useful in the removal of freckles when applied as a wash to the 
skin. In persons having an idiosyncrasy to boric acid a bullous erup- 
tion of the skin may follow its use. 

Borated lint is made by dipping lint into a boiling saturated solution 
of boric acid or borax. It is a simple, inexpensive antiseptic surgi- 
cal dressing, and contains nearly one-half its weight of the drug. 
Mel Boracis, B. P., is not official in the U. S. P. It is used as a local 
application for sore mouth. 



BOROGLY0ERIN. 

Boroglycerin (Glycerinum Acidi Borici, B. P.) is made by mixing 
62 parts of boric acid with 92 parts of glycerin in a tarred porce- 
lain capsule at a temperature of not more than 302° F. The acid is 
added to the glycerin gradually, with constant stirring. When the mix- 
ture has been reduced to the weight of 100 parts, it is poured on a flat 
surface wet slightly with petroleum, and on hardening is cut into blocks, 
which should be placed at once in a well-stoppered bottle. When used 
for medicinal purposes the glycerite of boroglycerin (Glyceritum Boro- 
glycerini, U. S.) should be employed, which may be made by adding 1 
ounce (30.0) of the boroglycerin in solid form to 1 ounce (30.0) of 
glycerin and heating in a dish while stirring. It is soluble in water. 
Locally the glycerite of boroglycerin is used as an antiseptic and as a 
vehicle for carbolic acid, chrysarobin, and the vegetable alkaloids in the 
treatment of skin diseases, and in diseases of the eye, such as puruleni 
ophthalmia. 



BROMIDES. 125 



BROMETONE. 



Brometone is produced by the action of caustic alkalies upon 
bromoform and acetone; it occurs in fine white prismatic crystals 
which possess a camphoraceous odor and taste. Its melting point is 
about 167° C. It is soluble in most of the organic solvents, a ; alcohol, 
ether, benzine, etc., slightly soluble in cold and more soluble in hot 
water. Its chemical name is tri-brom-tertiary-butyl -alcohol, and it 
contains 77 per cent, of bromine. 

The physiological action of brometone is nearly identical with that 
of the older bromides. Given in full doses it may, in susceptible 
persons, produce some dizziness, vertigo, loss of appetite, or mental 
heaviness, which are, however, only fleeting in their nature. Brome- 
tone may, therefore, be used as a substitute for the other bromides. 
It possesses the advantage of being powerful and therefore is efficacious 
in small doses varying from 2 to 10 grains (0.12-0.6) which are best 
given in capsules. 

BROMIDES. 

Bromides of Potassium, Sodium, Lithium, Calcium, Gold, Nickel, 
Ammonium, Strontium, and Hydrobromic Acid. 

Bromide of Potassium. 

Bromide of Potassium (Potassii Bromidum, U. S. and B. P.) is 
the most commonly used and an important member of the group 
above named, and will therefore be spoken of before the others. It 
is prepared by precipitating freshly-made bromide of iron with 
pure carbonate of potassium, or by a process more readily carried out 
and recommended by the B. P. It occurs in colorless transparent 
crystals, which are stable in dry air, but absorb moisture in a damp 
atmosphere. It is very soluble in water, but less so in alcohol. This 
bromide has a salty taste, and is distinctly irritant to mucous mem- 
branes if locally applied in concentrated form. A certain portion of 
its depressant influence, particularly when it is given for long periods 
of time, depends upon the potassium as much as upon the bromine, and 
for this reason the sodium salt is preferable. 

Physiological Action. — Bromide of potassium has an action upon 
the animal economy which is clearly defined and closely followed by all 
the other bromide salts, so that what is said in this place concerning its 
effects may be taken as representing the whole class of bromides, except 
in the instances where slight differences exist, which will be pointed out 
under the various names of the respective salts. When taken internally 
in full doses it produces drowsiness, sleep, and a decrease in all the 
reflexes. (See effects of Prolonged Use.) 

Nervous System. — The bromide of potassium acts as a distinct de- 
pressant to the motor and to the intellectual portions of the cortex cerebri. 
It slows the development of thought and decreases the excitability and 



126 



I)R UGS. 



power of the motor cells of the brain (Albertoni). Upon the spinal cord it 
acts as a marked sedative, affecting chiefly the sensory tracts, and causing 
thereby loss of reflex action and a decrease in the ability to recognize 
pain. It also depresses, but to a less extent, the motor pathways in the 
cord. Motion is maintained after sensations to pain and reflexes are lost. 
The drug depresses the peripheral parts of the sensory nerves, and after 
very large doses the motor nerves and muscles are similarly involved. 

Circulation. — If the drug be injected in ordinary dose into the 
jugular vein, it causes at once a fall of arterial pressure and pulse-rate. 
These changes are due to a direct action of the bromine and the potas- 
sium upon the heart. When given to a man in therapeutic doses by the 
mouth, its circulatory effect is so slight as not to be worthy of considera- 
tion unless the dose is very large and repeated. 

Respiration. — In toxic dose bromide of potassium is a depressant to 
the respiratory centre. In medicinal dose it does not affect the breath- 
ing, except when the amounts given are large and the drug persistently 
administered, when the breathing becomes slower. 

Fig. 16. 




A, the bromides depress the motor areas and B, intellectual areas in the brain; C, they depress 
the sensory tracts in the spinal cord; D, they depress reflex action by depressing the sensory 
cells in the cord a. 



Digestion. — The bromides may disorder the stomach by irritating 
its mucous membrane or by so decreasing reflex action that the proper 
secretion of gastric juice is retarded, with the result that digestion does 
not take place with sufficient rapidity. For similar reasons they may 
cause constipation. 

Temperature. — No effect upon this function is noted unless the 
dose be enormous: when such a dose is given the bodily heat is pro- 
gressively diminished, the fall of temperature being probably due to the 
circulatory and nervous depression produced, associated with the gen- 
eral failure in vital power. 



BROMIDES. 127 

Elimination. — The drug escapes unchanged very slowly with all the 
secretions, and is found in the sweat, urine, tears, semen, milk, and feces. 

Tissue-waste is decreased when the animal economy is under the 
influence of one of the bromides. 

Therapeutics. — From what has been said, it is evident that bromide 
of potassium is a remedy to be devoted almost entirely to the treatment 
of disorders of the nervous system, and its uses are, therefore, as 
various as the manifestations of perversion of nervous action can be 
various. In a word, it may be said that bromide of potassium is to be 
used wherever over excitement of nervous protoplasm is present, but never 
where nervous symptoms are due to depression. 

In epilepsy, which, to the best of our knowledge, is due to explosive 
impulses arising in the cerebral cortex, it is one of the best drugs we 
have if given in sufficient dose; and in all forms of minor spasm, due 
to heightened reflex activity, it is of service. Care should be used 
in giving this drug in epilepsy that maniacal excitement does not 
supplant the attacks of epilepsy. (See Epilepsy, Part IV.) In cases 
of spasmodic contractions, in the treatment of hysterical females, in 
nervous stariings and alarm at sudden noises in adults and children, 
and in the nervous symptoms accompanying pregnancy and the meno- 
pause the bromides will be found of great value. The following pre- 
scription was recommended very highly by Goodell, and will be found 
of service in the latter states: 

1$ — Ammonii bromidi 5ij (8.0). 

Potassii bromidi 5iv (16.0). 

Spts. ammon. aromat f ovj (24.0). 

Aquae camphorse q. s. ad t'ovj (180.0). — M. 

S. — A dessertspoonful (8.0) to a tablespoonful (16,0) every four hours. 

In headaches due to uterine trouble the pain is often felt at the top 
of the skull or at the back of the neck near the occiput. The cause 
of this trouble will sometimes be found to be in the cervix uteri, and 
relief under these circumstances can only be obtained when the uterus 
is treated and the bromides administered. 

In convulsions in children- and adults, combined with chloral, bro- 
mides are most efficient, and are sometimes of service in incontinence 
of urine due to vesical spasm. In seminal emissions due to a morbid 
excitability of the centres in the spinal cord, bromide of potassium is 
one of the best remedies we have, and in satyriasis and nymphomania 
it is of great service. 

In cases where undue irritability of the pharynx and larynx prevents 
examination of these parts, one or two full doses will render an exami- 
nation easy of performance by decreasing the local reflex activity. 
This is a useful point to be remembered in relation to the treatment 
of pharyngeal and laryngeal disease. 

In cases of acute laryngitis full doses of the bromides (60 to 120 
grains [4.0-8.0] a day) are very useful to allay the pain and hoarseness. 

The bromides are found to be of service in the laryngeal crises of 
locomotor ataxia, the explanation of this fact being as follows: The 



128 DRUGS. 

adductor centre of the larynx is situated in the brain, and the abduc- 
tor centre in the spinal cord. The first closes the larynx, the second 
opens it, and in health they maintain a patulous tube by their oppo- 
sition. In disease the spinal centre (the abductor or opener) fails, 
and the adductor in the brain, being unopposed, produces closure of 
the tube with disastrous results. The bromide, by quieting reflex 
action, as well as depressing the adductor centre in the cerebral cortex, 
prevents this accident. 

In whooping-cough with much mucous exudation the drug is rarely 
of benefit, and had better not be used. In laryngismus stridulus or 
any form of spasm depending upon local irritation the local trouble 
must, of course, be removed if possible and the bromides given. In 
teething the drug may be used to decrease reflex irritation and prevent 
convulsions, and it will decrease the night-screaming of children — 
which is often due to bad dreams — to a very extraordinary degree, 
even if the dose be quite small. As a soporific for the insane and in 
the insomnia of the overworked and that of nervous women the bro- 
mide of potassium is of great service, but ought to be used as a tem- 
porary measure only. (See Insomnia.) It may also be employed 
with good results in chronic alcoholism and morphiomania, given in 
doses of 40 to 60 grains (2.6-4.0). In migraine and neuralgia due to 
eye-strain or nerve-strain, combined with caffeine the bromides are 
almost specifics. The caffeine seems to stimulate the depressed nerve 
up to the normal level, and the bromide to deaden* the perception of 
the pain. The following is a most valuable remedy in migraine, and 
also in sick headache. It ought not to be used in bilious headache, 
which will often be made worse by it: 

R — Antipyrinae gr. xxv (1.6). 

Caffeinae citratae gr. x (0.60). 

Potassii bromidi gr. xxv. (1.6). — M. 

Ft. in chart. No. v. 

S. — One powder as needed. 

In the treatment of dysmenorrhea and menorrhagia, ' particularly 
in young subjects, the bromides are also of service. (See Goodell's 
prescription, page 127.) When the flow is too profuse, the drug 
should be begun a week before the expected epoch, and given in the 
dose of 5 to 10 grains (0.3-0.60) night and morning. In cases 
where the epochs follow one another too closely the drug should be 
used continuously. After an apparent cure ensues the bromide should 
be continued for a few periods to avoid a relapse. For sea-sickness 
the bromides are the best prophylactics we possess, and should be 
used in the dose of 5 to 10 grains (0.3-0.60) three times a day for several 
days before the patient sails, in order to quiet the vomiting centre. 
After sea-sickness begins they should not be given in ordinary solution, 
but in an effervescing draught made as follows: 

1$ — Acid, .citric oij (8.0). 

Aquae dest fgiv (120.0).— M. 

Ft. sol. 



BROMIDES. 129 

1$ — Potassii bromidi 5j (4.0). 

Potassii bicarbonatis 3j (4.0). 

Aquae dest fgiv (120.0).— M. 

Ft. sol. 
S. — A tablespoonful (16.0) of each of these solutions should be added to one 
another and taken during effervescence. 

This prescription will also be found of value in the persistent vom- 
iting of pregnancy and in that following prolonged etherization or 
other states. If the vomiting is excessive, the dose ought to be reduced 
to 2 teaspoonfuls (8.0) of each solution, and be given every half-hour 
until half of each mixture is taken or the patient is relieved. In cases 
where this cannot be retained, a rectal injection of the following will 
be found of value: 

Py — Sodii bromidi gr. xxx vel 3j (2.0-4.0). 

Tinct. opii deodorat TTlxxx (2.0). 

Aquae amyli fgvj (180.0).— M. 

S. — To be injected gently into the empty rectum and retained as long as 

possible. 

This method is the most reliable plan that can be followed. 

Bromide of potassium may be used to prevent the development 
of symptoms of cinchonism, which often ensue after the use of quinine 
and salicylic acid, and it is said to prevent the nausea and depression 
so apt to follow the use of opium. 

Administration. — The dose of bromide of potassium is from 5 to 
120 grains (0.3-8.0) a day. It should be given at long intervals, as 
it is slowly absorbed and very slowly eliminated. After the patient 
is fully under its influence its effects can be maintained by smaller 
doses. The best way to order it is in a watery solution with a little 
syrup. 

Use of Bromides in Poisoning. — Bromides are useful in nearly all 
convulsive attacks consequent upon the ingestion of poisons, and 
they may be used to allay any nervous symptoms arising from this 
cause which are of an exciting nature. 

Poisoning. — Acute poisoning by the bromides is rare, but if half to 
one ounce is taken they produce a sense of warmth in the epigastrium, 
general feebleness, frontal headache, stupor, aphasia, and amnesia. 
The pulse-rate decreases 15 to 20 beats a minute; the pulse is irreg- 
ular and compressible. Recovery takes place, as a rule, unless pul- 
monary oedema sets in. 

Effects of Prolonged Use, or Bromism. — After the drug has been 
used for some time in large doses acne appears about the face and 
extends over the entire body; the breath becomes fetid, the patient 
is dull, expressionless, and heavy, and remains buried in sleep during 
nearly every hour of the day. During this time he can be aroused, 
but at once sinks to sleep again. The gait becomes weak and feeble, 
the movements slow and prolonged. Taste is lost and hearing is 
benumbed, while the intellectual faculties of the brain are almost 
in abeyance. Loss of sexual power is an early symptom. In other 



130 DRUGS. 

cases evidences of mental aberration develop, the patient becoming 
irritable, morose, and even homicidal. Sometimes, however, we find 
melancholia and hallucinations, and rarely exalted ideas. 1 In still 
others a dangerous suffocative bronchitis develops, the patient may 
become profoundly cachectic, or the condition may resemble typhoid 
fever. The acne may be prevented to some extent by the use of arsenic, 
and when the bromides are given to women this drug may be given 
simultaneously to prevent the eruption. As Fowler's solution is com- 
patible with the bromide in solution, it is the best form of arsenic 
to employ. As the acne is due to a torpid state of the skin-glands, it 
is also well in these cases to order the patient to wash with warm 
water and Castile soap every night, and afterward to dry the face by 
a vigorous rubbing with a rough towel. Fere has asserted that the 
maintenance of intestinal antisepsis by the use of naphtol or salol will 
prevent the development of acne and digestive disorder when the bro- 
mides are given. 

Contraindications. — The bromides are contraindicated wherever 
there is general asthenia and feebleness of the nervous system, as, for 
example, in post-typhoidal and post-puerperal insanity. In senile 
softening of the brain they are also harmful. When the mucous 
membrane of the gastro-intestinal tract is irritated, they do harm. 
When the patient is subject to acne, they should be used with caution 
or avoided. 

Bromide of Ammonium. 

(See Ammonium Bromide.) 

Bromide of Calcium. 

Calcium Bromide (Calcii Bromidum, U. S.) was introduced into 
medicine as a nervous sedative and hypnotic, and was thought at one 
time to be an efficient substitute for the bromide of potassium. Its 
action on the nervous system is virtually identical with that of the 
potassium salt, and it has been found to be far less irritant and depres- 
sant than the latter. For some unknown reason it has never won the 
confidence of the profession, but it may be given with very good results 
in the dose of from 30 to 90 grains (2.0-6.0) a day, or even more in 
cases which are not readily affected by bromides. It may be employed 
in hysteria and epilepsy and in all the conditions in which the other 
bromide salts are indicated. It is sometimes of value combined with 
the potassium salt, since under such circumstances better results are 
gained than if a single salt is employed. 

Bromide of Gold. 

The Bromide of Gold has been employed in epilepsy by a number 
of clinicians with great success in the dose of from ^ to J grain (0.012- 

1 See Collective Investigation by author in the Therapeutic Gazette of June 15, 1897; also 
article on Epilepsy, Part IV. 



BROMIDES. 131 

0.03) three times a day in pills. Physiological studies have proved 
that the drug is a direct sedative to the motor cells in the cortex 
cerebri. 

Bromide of Lithium. 

Bromide of Lithium (Lithii Bromidum, U. S.) is much weaker than 
the other salts, and must be given in larger dose. S. Weir Mitchell 
states that it is of value in epilepsy when the potassium salt fails. 
The dose is 30 to 90 grains (2.0-6.0) a day. 

Bromide of Nickel. 

Bromide of Nickel is a green salt quite irritant to the stomach. 
The author has made an experimental study of this salt and found it 
practically identical with the bromide of potassium in physiological 
action. It should be given well diluted or in an effervescing draught, 
as it is apt to disorder the stomach if used in concentrated solution. 
The effervescing form of the drug is made by mixing the salt with 
bicarbonate of sodium and tartaric acid, moistening with alcohol, 
passing the moist powder through a sieve, and then drying it in a 
warm closet. 

Bromide of Sodium. 

Bromide of Sodium (Sodii Bromidum, U. S. and B. P.) is to be 
used in every instance where bromide of potassium can be employed. 
Its dose is the same, although it is asserted to be a little weaker 
physiologically, grain for grain, than the potassium salt. It is far 
less apt to disorder the stomach, and is not so generally depressant 
as is the bromide of potassium. 

Bromide of Strontium. 

(See Strontium.) 



Hydrobromic Acid. 

Hydrobromic Acid is an extremely irritant preparation, but is 
thought to be less apt to cause acne and other untoward effects than 
the other bromides. It is only to be used in the form of the official 
dilute acid (Acidum H ydrobromicum Dilutum, U. S. and B. P.), and 
to be given in the dose of from 1 drachm to § ounce (4.0-15.0) 
Well diluted with sweetened water. It is highly recommended by 
de Schweinitz and others for headaches due to eye-strain in nervous 
women. 

Bromide of Ethyl. 
(See Ethyl Bromide.) 



132 I) BUGS. 

BROMINE. 

Bromine (U. S.) is a dark-red liquid of an excessively pungent 
odor, like that of chlorine, possessing extraordinary power as a 
caustic when applied to the tissues" of the body. It is the most severe 
caustic we possess, and penetrates very deeply. It may be applied in 
hospital gangrene and other large sloughs by means of a glass rod. 
Bromine should be kept in glass-stoppered bottles in a cool place. 

BROMOFORM. 

Bromoform, or Tribromomethane, is a clear, colorless liquid hav^ 
ing a peculiar odor and sweet taste. It is readily soluble in alcohol, 
but slightly so in water. Bromoform which is to be used medicinally 
should be protected from sunlight and air, and must be free from 
color and from acid. 

Therapeutics. — Although bromoform has been found capable of 
producing anaesthesia when given by inhalation, its employment in 
medicine is practically confined to the treatment of whooping-cough, 
when it is given internally in the dose of 2 to 5 minims (0.1-0.3) three 
times a day for the relief of the spasmodic cough. Bedford has sug- 
gested the following formula for its internal use: 

I$— Bromoform mxvj (1.0). 

Alcohol foij (8.0). 

Glycerin.. . . fSxij (45.0). 

Tinct. cardamomi comp. . . . q. s. ad f Sij (60.0). — M. 
S. — Teaspoonful (4.0) t. i. d. in water. 

This prescription should be compounded by adding the ingredients 
in the order named. 

Bromoform tends to depress the vasomotor system, but does not 
seem to depress the heart itself. While it seems to possess therapeutic 
value, the large number of cases reported in which it has caused alarm- 
ing symptoms has prevented the author from employing it. 

BRYONIA, or BRYONY. 

Bryonia is a remedy very largely used by irregular physicians, and 
is probably too much ignored by reputable physicians, for it possesses 
very great power, and often relieves conditions which are obstinately 
persistent under other treatment. It is the root of Bryonia alba or 
Bryonia dioica. The preparation commonly employed is the tincture 
(Tinctura Bryonia?). The dose of the powdered root as a drastic 
purge is 10 to 40 grains (0.6-2.6). 

Physiological Action. — In overdoses bryonia acts as a hydragogue 
cathartic and gastro-intestinal irritant. On serous membranes it 
exercises an irritant influence, and may produce symptoms of menin- 
gitis when given in poisonous doses. In moderate doses bryonia 
causes some flushing of the face and neck and headache in susceptible 



BUCSU. 133 

persons. The drug needs studying from a pharmacological point of 
view. 

Therapeutics. — Although one of the oldest of remedies, bryonia has 
been given a new impetus by the homoeopaths, who employ it in a 
number of affections. In the treatment of dyspepsia depending upon 
gastric and intestinal atony or the abuse of alcohol or other similar 
causes bryonia often gives relief. Its influence is exerted through the 
irritant effects it produces, for by this means it stimulates or spurs the 
atonic digestive glands to increased activity. For this reason it has 
been found particularly useful in children who suffer from constipation 
resulting from insufficient secretion on the part of the intestinal glands. 
When the passages are dry and friable and resemble in character those 
of a dog, bryonia is of great value. The dose for a child is about 
10 to 30 minims (0.60-2.0). The drug has been praised as a remedy 
in the treatment of rheumatism and in pleurisy, but little is recorded 
as to its real value in these diseases. In pleurisy with effusion drastic 
doses have been used, but the saline purgatives are safer and more 
efficacious remedies. 

Administration. — The dose of the tincture of bryonia (Tinctura 
Bryonia?) is from 1 to 2 fluidrachms (4.0-8.0) as a laxative; but the 
so-called mother-tincture of the homoeopaths is perhaps the best 
preparation for ordinary use. The proper amount to be used in the 
treatment of a case of dyspepsia is from 5 to 40 minims (0.3-2.6), 
unless the mucous membranes are very torpid, when this quantity 
may be increased. 

BUCHU. 

Buchu (U. S.) is derived from Barosma betulina, a plant of Africa. 
It contains a volatile oil, which is probably the active principle, and 
a bitter extractive. It is official, under the name of Buchu Folia, in 
the B. P. 

Therapeutics. — Buchu is used when it is desired to affect the mucous 
membranes of the genito-urinary tract which are chronically diseased, 
and particularly when these parts are below their normal tone. It 
does not increase the urinary flow to any great extent, but acts on the 
mucous membrane of the genito-urinary passages as a stimulant. It 
is employed in pyelitis, cystitis, and vesical irritation of a chronic 
type. The following prescription is useful: 

1^ — Potassii citratis 3iv (16.0). 

Spt. chloroformi . f5iij (12.0). 

Tinct. digitalis tTVxxx (2.0). 

Infusi buchu q. s. ad f oviij (240.0).— M. 

S. — Two tablespoonfuls (30.0) three times a day. Shake the bottle before using. 

If the urine is continually highly acid, muddy, laden with salts, 
and productive of incontinence by reason of the vesical irritation 
which it produces, buchu in the form of the fluid extract, in the dose 
of a teaspoonful (4.0) three times a day, combined with an equal 
amount of sweet spirit of nitre and 20 grains (1.3) of acetate of potas- 



134 DRUGS. 

sium, will be of great service. For a child the dose of the fluid extract 
should be about 10 to 30 minims (0.6-2.0). If the vesical irritation 
is acute, buchu is contraindicated. 

Administration. — The fluid extract (Fluidextractum Buchu, U. S.) 
is the only official preparation, and it should be always well 
diluted before it is given, in the dose, to an adult, of 1 drachm (4.0) 
three times a day. The infusion is not official, but is made by adding 
1 ounce (30.0) of the leaves to a pint (480 c.c.) of water. The dose 
of this is J ounce (16.0) to 1 ounce (30.0). The official B. P. prepara- 
tions are the infusion (Injusum Buchu), dose 1 to 4 fluidounces (30.0- 
120.0), and the tincture (Tinctura Buchu), dose 1 to 2 fluidrachms 
(4.0-8.0). 

CACTUS GRANDIFLORUS. 

This is a plant of Mexico and the West Indies. There are other 
species of Cactus possessing medicinal power, but Cactus grandi- 
florus is the most active so far as a medicinal effect upon the heart is 
concerned. 

Cactus grandiflorus is best given in the form of the tincture or the 
fluid extract made from the green plant. 

Physiological Action. — The drug has been studied by Myers and 
Boinet and Teissier, who have found that it causes a distinct increase 
of arterial pressure, but does not slow the pulse, sometimes increasing 
its rapidity. Myers has also shown that the drug is a stimulant to 
the vasomotor centres and to the motor ganglia of the heart-muscle. 
It also acts as a stimulant rather than a depressant to the spinal cord. 

Therapeutics. — Cactus grandiflorus has proved itself a good sub- 
stitute for digitalis in certain diseases of the circulatory apparatus, 
such as cardiac palpitation and weakness. It has also been found 
very serviceable as a remedy in cardiac failure the result of valvular 
disease, but in all such cases seems to act best when added to some 
more powerful drug, such as digitalis, as it takes the part of an adjuvant,, 
Cactus also acts well in some cases of angina pectoris. 

Administration. — The dose of the tincture of cactus is 2 to 8 minims 
(0.1-0.50) and of the fluid extract 2 to 4 minims (0.1-0.25). 

Untoward Effects. — It is claimed that these do not occur, and that 
the drug never produces a cumulative effect. 

CAFFEA. 1 

Caffeine (Cafjeina, U. S. and B. P.) is an alkaloid derived from 
the berries of Cafjea Arabica, which also contain, upon roasting, an 
empyreumatic oil, caffeol or caffeone. Caffeine is usually employed 
in medicine as caffeine and the citrated caffeine (Cafjeina Citrata, 
U. S.; Cafjeina? Citras, B. P.). Citrated caffeine is not regarded by 

1 Theine, derived from tea, caffeine, the active principle of coffee, and the alkaloid of guarana 
from South America, are chemically identical. Much of the caffeine of commerce is really theine, 
although it is claimed that pure theine has a very different physiological action. 



CAFFEA. 



135 



Fig. 17 



chemists as a chemical compound, but as a mixture of citric acid and 
caffeine; therefore " citrate of caffeine " is an incorrect term. It is 
soluble in 3 parts of water. If more water is added, it is partly precipi- 
tated, but when 25 parts are added it is redissolved. In the U. S. P. 
another official preparation of caffeine, the Cafjeina Citrata Ejferves- 
cens (Caffeines Citras Effervescens, B. P.), has been introduced as an 
agreeable preparation for use in cases of headache, particularly if 
combined with one of the bromides and antipyrin. The dose is from 
i to 2 drachms (2.0-8.0). 

The empyreumatic oil, of which there is about one-half to one tea- 
spoonful in each well-made breakfast-cup of coffee, has no physiologi- 
cal effects. It is perhaps the cause of the " biliousness" sometimes 
produced by the habitual use of 
coffee, due to the faulty digestion of 
this oil, which is also prone to dis- 
order the digestion if taken alone. 

Physiological Action. — Nervous 
System. — On the nervous system 
caffeine acts as a rapidly-acting 
stimulant, exerting its chief influ- 
ence on the brain and spinal cord. 
By its cerebral effect it causes in- 
creased rapidity of thought, and by 
its influence on the spinal cord it 
increases reflex activity, and for this 
reason is said to make people "ner- 
vous." It is important to remem- 
ber that it has no effect on brain 
protoplasm except to stimulate it, 
and that ultimately a brain driven 
along by caffeine breaks down by 
the concentration of its energy for 
the time being in one effort. 

Circulation. — Caffeine has been 
supposed to increase the pulse-rate 
and blood-pressure by stimulating 
the heart-muscle, but from recent 
studies in the United States and 
abroad it would seem probable that 
these changes are indirectly pro- 
duced and due solely to its stimu- 
lating action on the nervous system. Clinically, it certainly seems 
to raise the blood-pressure in almost every instance where it is 
used. 

Kidneys, Tissue- waste, and Elimination. — Caffeine increases 
diuresis by causing dilatation of the renal vessels, particularly in the 
glomerules, and by preventing the absorbent action of the tubules. It 
also exerts a direct stimulating influence on the secretory epithelium 




Caffeine dilates bloodvessels of the Mal- 
pighian tuft (A) and stimulates the secreting 
epithelium lining the uriniferous tubules (B). 



136 DRUGS. 

of the kidney, and therefore increases the amount of solids as well 
as of the liquids in the urine. Upon tissue-waste the drug acts as a 
depressant, and is therefore a conservator of the tissues. It is oxidized 
and destroyed in the body. 

Respiration. — Caffeine acts as a powerful stimulant to the respira- 
tory centre. 

Therapeutics. — Caffeine is a valuable cardiac stimulant and tonic 
as well as a renal stimulant. It acts equally w T ell in cardiac and renal 
dropsies for this reason, and is an invaluable remedy in such cases. 
So useful is caffeine in cases of cardiac disease that it has largely sup- 
planted digitalis in the hands of some practitioners. In acute renal 
inflammation it is contraindicated, because all stimulants are contra- 
indicated when the part they influence is inflamed. In opium poison- 
ing, owing to its stimulant effect on the respiratory centre, caffeine is 
very valuable. Under these circumstances it may be given by the 
mouth or rectum in the form of strong black coffee, which will also aid 
in keeping the patient awake and add heat to the body, which is often 
very cold. A cup of strong black coffee is often useful in relieving a 
paroxysm of asthma. In headache due to nerve-strain caffeine com- 
bined with antipyrin and one of the bromides is of the greatest service. 
(See Neuralgia.) 

Roasted coffee is sometimes used to mask the taste of disagreeable 
medicine. After it is roasted and ground it may be employed as an 
antiseptic and deodorant dressing for wounds when the common anti- 
septics are not obtainable. 

Administration. — The ordinary dose of caffeine is 2 to 4 grains 
(0.12-0.25). 

Cafjeina, U. S. and B. P., cannot be used hypodermically, owing 
to its decomposition in the presence of water. The following solution 
may, however, be used hypodermically: Salicylate of sodium, 30 
parts; caffeine, 40 parts; and distilled water, 60 parts; or, in other 
instances, the following preparation, recommended by Huchard, may 
be employed: Benzoate of sodium, 45 grains; caffeine, 30 grains; dis- 
tilled water, 75 grains. This mixture is to be heated, and 10 minims 
(0.60) given at a dose. 

Untoward Effects. — Caffeine often produces so much insomnia 
when given in cases of cardiac disease that its use has to be discon- 
tinued. If its use is persisted in, it may produce a condition of delirium 
closely resembling that of alcoholism; and if too large doses are used, 
or it is too frequently repeated, it may cause a decrease in urinary flow 
by causing spasm of the renal vessels. The writer has also seen a 
marked rise of temperature follow its use in the dose of 2 grains (0. 1 2) 
three times a day, but this is unusual. In certain persons the 
habitual use of coffee may cause insomnia, tremors, palpitation, tin- 
nitus aurium, gastralgia, and emaciation. 



CALCIUM. 137 

CAJUPUT OIL. 

Oil of Cajuput (Oleum Cajuputi, U. S. and B. P.) is a volatile oil 
distilled from Melaleuca Leucodendron, a tree of the Molucca Islands. 
It is a stimulant, and in large amounts an irritant, to mucous mem- 
branes, but acts as an efficient carminative and parasiticide in mod- 
erate amounts. As a remedy for tinea tonsurans and pediculi it should 
be applied pure to the part affected and used with caution, for cajuput 
oil is capable of irritating the skin. In diarrhoea of a serous type 
it is of value in the dose of 10 to 20 minims (0.60-1.30). (See 
Diarrhoea.) Spiritus Cajuputi is official in the B. P.; dose J to 1 
fluidrachm (2.0-4.0). 

CALCIUM. 

Calcium is official in a number of forms, and is to be distinctly 
separated in the mind of the student from calx or lime, which is an 
oxide of calcium. It is never employed as calcium, but as one of its 
salts. These are as follows: bromide of calcium (Calcii Bromidum, 
U. S.); precipitated carbonate of calcium (Calcii Carbonas Proecipi- 
tatus, U. S. and B. P.) ; chloride of calcium (Calcii Chloridum, U. S. 
and B. P.); hypophosphite of calcium (Calcii Hypophosphis, U. S. 
and B. P.); and as precipitated phosphate of calcium (Calcii Phosphas 
Proecipitatus , U. S. ; Calcii Phosphas, B. P.). Calcium sulphate is 
official in the B. P. 

All salts of calcium are incompatible with acids. 

The precipitated carbonate of calcium is used in the treatment of 
serous diarrhoea as an antacid, and as a local protective in cases of 
chapped skin or intertrigo, particularly in young children. When 
given internally the dose is from 10 to 30 grains (0.60-2.0), but by 
far the best method for its administration is in the employment of 
chalk mixture (Mistura Cretoe, U. S. and B. P.), which contains 
about 30 grains of the chalk to each ounce (2.0-30.0) of liquid. The 
dose of this mixture is from 1 drachm (4.0) for a young child to an 
ounce (30.0) for an adult. In the treatment of cases of serous diarrhoea 
chalk mixture is best given in combination with tincture of kino or 
the compound tincture of catechu and paregoric, in some such form 
as follows: 

3— Tr. kino . . fSj (30.0). 

Tr. gambir comp f 3 i j (8.0). 

Misturae cretae . . - . . . . q. s. ad fgvj (180.0). — M. 
S. — A dessertspoonful (8.0) every three hours till diarrhoea ceases. 

It is to be remembered that the chalk mixture acts very slightly as 
an astringent, and chiefly as an antacid and mechanical agent in the 
alimentary canal. 

Precipitated carbonate of calcium is the slowest acting antacid which 
we possess, and for this reason the remedy is to be employed in acidity 
of the intestines, as it passes through the stomach to a very great 



138 DRUGS. 

extent unchanged. (For the varieties of diarrhoea in which it is to 
be used see article on Diarrhoea.) As an external operation it is 
used in sweating of the feet and hands, and sometimes as a dry dress- 
ing to ulcers. It may also be used over burns. 

Calcium chloride, when taken internally in large amount, acts as an 
intense gastro-intestinal irritant, and may produce death by this means. 
It is to be distinctly separated from the chlorinate or chloride of lime, 
w T ith which it is sometimes confused, for the latter is hydrate of 
lime or slaked lime, containing 35 per cent, of chlorine, while 
chloride of calcium is a hard, vitreous, friable substance, giving 
off no odor of chlorine and utterly different in its use, action, and 
appearance. 

Chloride of calcium is used in medicine by some physicians in the 
treatment of scrofulous enlargements of glands in the neck and else- 
where, and is even said to cause calcification and encysting of tuber- 
cular nodules. In cases where deficient bone-formation is evident it 
often does good, but the other salts of calcium, such as the lactophos- 
phates, are better. In cases where boils mature slowly a poultice 
made by adding a solution of chloride of calcium to the mass may 
be used to hasten suppuration. The dose internally is 5 to 30 grains 
(0.30-2.0), best given in a solution made by adding water in the pro- 
portion of 1 drachm (4.0) to each 5 grains (0.30) of the drug. 

Another use of calcium chloride which is one always worthy of trial 
is its employment in the treatment of itching. It should be given in 
the dose of 20 grains (1.3) three times a day to an adult, and may be 
prescribed as follows: 

I£— Calcii chloridi 3ij (8.0). 

Tinct. aurantii flor f5vj (24.0). 

Aquae chloroformi q. s. ad §vj (180.0). — M. 

S. — One to two tablespoonfuls (16.0-30.0) three times a day. 

Smaller doses may be needed if the stomach is irritable. These 
doses usually produce some thirst, and they should be taken about one 
hour after a meal. 

Small doses of calcium chloride have also been used to increase the 
coagulability of the blood in "bleeders," and to prevent attacks of 
urticaria by an influence on the blood-plasma. It should not be given 
longer than four days, as after this time it decreases the coagulability 
of the blood. When used, the dose should be 15 to 30 grains (1.0-2.0), 
followed by 5 grains (0.3) every hour till five or six doses have been 
taken. Unfortunately, as already stated, it is apt to disorder the 
stomach. 

MacCallum has recently shown that calcium chloride inhibits intes- 
tinal peristalsis, and suggests that it be used to control serous diarrhoea 
due to nervous atony. 

The hypophosphite of calcium and the precipitated phosphate of 
calcium are used for the treatment of scrofulosis or strumous states 



CALCIUM. 139 

and allied conditions, sucn as rachitis, generally in the form of the 
Syrupus Hypophosphitum, U. S., Syrupus Hyposphitum Compositus, 
U. S. and the Syrupus Calcii Lactophosphatis , U. S. and B. P. 

The large amount of phosphate of calcium normally present in the 
bones and tissues renders it a useful drug when the body is starved of 
its proper proportion of salts, and its use has been found, in animals, 
to cause a great increase in bony growth, not only in the earthy, but 
also in the animal, constituents of the osseous tissues. The hyposul- 
phite has a similar effect. 

In rickets and in fractures where the bone is slow in uniting, and 
in some cases of phthisis and scrofula, the lactophosphates and hypo- 
phosphites are of service. 

It is worthy of note that these salts are of little value in tubercu- 
losis after it is well developed. They do good chiefly in the 
so-called pretubercular or beginning stages of the disease; and the 
good effects of the so-called syrups of the hypophosphites depend more 
upon the other ingredients present in them than upon the calcium salts 
they contain. In dental caries, particularly that occurring in nursing 
women, and in the anaemia of this class of patients, they are useful. 

The lactophosphates are better than the hypophosphites, as the 
latter are probably changed into phosphates in the stomach as soon as 
they enter that viscus. The dose of either the lactophosphates or the 
hypophosphites is 10 to 30 grains (0.60-2.0) three times a day, or of 
the syrups just named a teaspoonful to a tablespoonful (4.0-16.0). 
The difference between these salts and phosphorus, both in thera- 
peutical effect and in physiological action, is to be clearly borne in mind. 
The lactophosphates and hypophosphites are simply convenient 
modes of administering calcium, potassium, or other substances, while 
phosphorus acts as a stimulant to bone-growth, and not by its deposi- 
tion in the bone. Phosphoric acid does not act any more like phos- 
phorus than does sulphuric acid act like sulphur. 

Sulphate of calcium is not to be confounded with calx sulphurata, 
often wrongly called sulphide of calcium. (See Boils and Calx.) 

Chalk. 

Chalk is a native calcium carbonate, chiefly obtained from shells. 

Prepared chalk (Creta Pr&parata, U. S. and B. P.) is given in the 
dose of 20 to 60 grains (1.3-4.0). Other preparations are compound 
chalk powder (Pulvis Cretw Compositus, U. S.), composed of prepared 
chalk, acacia, and sugar, and given in the dose of 10 to 60 grains 
(0.60-4.0), and troches of chalk (Trochisci Cretw). Mistura Creta?, 
or Chalk Mixture, is mentioned on p. 137. Preparations official 
in the B. P., but not in the U. S. P., are aromatic powder of chalk 
(Pulvis Creta 3 Aromaticus) , dose 10 to 60 grains (0.60-4.0), and Pulvis 
Creta? Aromaticus cum Opio, dose 10 to 60 grains (0 60-4.0). 



140 DRUGS. 



CALUMBA. 



Calumba (Calumba? Radix, B. P.). Columbo, or Columba, is the 
root of Jateorrhiza Palmata. Its taste is bitter and its color is slightly 
aromatic. Two alkaloids are found in it, berberine and colum- 
bine, and a third substance known as columbic acid. Calumba is one 
of the purest bitters known, as it does not contain tannic acid. 

Therapeutics. — Calumba is one of the best simple tonics that can 
be used, owing to its lack of astringent effect and to its favorable 
action on mucous membranes. 

In cases of gastro-intestinal atony, particularly that following fevers 
and similar states, calumba will be found of service, and it is a valuable 
remedy in the convalescent stages of summer complaint and serous 
diarrhoeas. The following prescription of Dr. George B. Wood is 
very useful in intestinal atony when associated with flatulence, 
although its bulk is disadvantageous and its taste bitter: 

&— Calumbse pulv. 3ss(16.0). 

Zingiberis pulv Jss(16.0). 

Sennse fol gj (4.0). 

Aquae bullientis Oj (480 c.c). — M. 

Ft. in infusum. 

S. — A wineglassful t. i. d. 

Administration. — The fluid extract (Fluidextractum Calumba;, U. S.) 
is given in the dose of 15 to 60 minims (1.0-4.0); the tincture 
{Tinctura Calumba 3 , U. S. and B. P.), dose \ to 2 fluidrachms 2.0- 
8.0 c.c). The dose of the infusion (Infusum Calumba 7 , B. P.) is \ 
to 1 fluidounce (16.0-30.0). Liquor Calumba Concentratus, B. P., 
is given in the dose of \ to 1 drachm (2.0-4.0), 

CALX. 

Calx (U. S. and B. P.), or Lime, or Oxide of Calcium, is an alkaline 
earth which is incompatible with acids, ammoniacal and metallic 
bases, borates, alkaline carbonates, and astringent vegetable infusions. 
It is prepared by burning pure white marble, oyster-shells, or the purest 
calcium carbonate. 

Therapeutics. — Lime is used for the purpose of acting as an eschar- 
otic, particularly on old ulcers and on hairy growths. It is never 
given internally except in the form of the hydrate or slaked lime. 
As an escharotic application lime is used in the official caustic 
Potassa cum Calce. When given internally it should always be used 
as Liquor Calcis, U. S. and B. P., or lime-water, and under these 
circumstances it acts as an antacid, as an aid to the digestion of milk 
by preventing too rapid and solid coagulation of the casein, and by 
exciting an increased gastric secretion. It is also feebly astringent. 
Given to infants and nursing women, it is probably utilized in the 
body in the formation of bone. It is also of value in diabetes, in the 
uric-acid diathesis, and in the excessive nausea and vomiting often 
seen in adults and children and due to acidity of the stomach. 
Teaspoonful doses of milk and lime-water, equal parts, will often 



CAMPHOR. 141 

be retained by such patients when nothing else will remain in the 
stomach. 

The dose of lime-water is 1 drachm (4.0) to 1 ounce or even 2 ounces 
(30.0-60.0). Externally applied, lime-water is of value in tinea capitis 
and similar states, and it is a good application in burns, when mixed 
with equal parts of linseed or olive oil, forming Linimentum Calcis, 
U. S. and B. P., or Carron oil. As a local application in membranous 
croup and diphtheria lime-water has a high reputation, and is believed 
to dissolve the membrane, but it does not compare in usefulness with 
peroxide of hydrogen. It may be used as a spray or by means of a 
swab. 

Liquor Calcis, or lime-water, is to be made by adding a piece of 
unslaked lime as large as a walnut to 2 quarts of boiled and filtered 
water in an earthen jar; after stirring it thoroughly allow it to settle, 
and pour off the clear liquid into a bottle. More water may then be 
added to the lime until it is all used. 

Sulphurated lime (Calx Sulphurata, U. S. and B. P.) is useful to 
check inflammation and hasten suppuration; the dose is T V to J 
grain (0.006-0.03). It is of great value in acne pustulosa and all forms 
of cutaneous suppuration. Where sulphurate of lime is not obtainable 
and successive crops of boils appear, it is often possible to relieve 
the patient by baking egg-shells in an oven, powdering them, and 
then letting the patient eat 1 drachm (4.0) or more of the powder 
each day. 

The preparations of the B. P. that are not official in the U. S. are 
the saccharated solution of lime (Liquor Calcis Saccharatus) , dose 15 
to 60 minims (1.0-4.0), and slaked lime (Calcii Hydras), used in mak- 
ing different preparations. 

(For Calx Chlorinata, see Chlorinated Lime.) 

CAMPHOR. 

Camphor (C amphora, U. S. and B. P.) is derived from Cinna- 
momum Camphora, which grows chiefly in China and Japan. The 
camphor used in the drug-stores is refined camphor, and is obtained 
by repeated sublimation. It is a volatile irritant stearopten, produc- 
ing a burning sensation in the mouth and possessing a peculiar odor, 
soluble in 1000 parts of cold water and in 1 part of strong alcohol. 
Camphor is so volatile that if exposed to the air for any length of 
time it is wholly volatilized. It is an exceedingly combustible sub- 
stance, burning with a smoky flame. It may be white or pinkish in 
color. 

Physiological Action. — If taken in large amount, camphor pro- 
duces epileptiform convulsions, preceded by vertigo, roaring in the 
ears, and delirium. The pulse soon becomes rapid, feeble, and run- 
ning, and the skin livid, cold, and covered with sweat. Intense heat 
and burning may be felt in the belly, and, if the poisoning be slow, 
evidences of gastro-intestinal and renal inflammation ensue. In small 



142 DRUGS. 

doses it acts as a stimulant and gives a sensation of warmth to the 
stomach, while the pulse may become more rapid and stronger under 
its influence. At the same time there is a sedation of the nervous 
system and a general feeling of contentment. In large medicinal 
dose camphor is thought by some to act as a sexual stimulant, and by 
others as a sexual sedative. The stimulant effect is probably only 
produced by doses large enough to produce irritation of the genito- 
urinary tract. The convulsions following poisonous doses are due to 
the action of the drug on the brain. The drug, although largely 
destroyed in the body, is chiefly eliminated by the kidneys as campho- 
glycuric acid, and also escapes by the breath and the perspiration. 

Therapeutics. — Internal Use. — Camphor is employed for the 
purpose of acting as a nervous sedative and antispasmodic in the treat- 
ment of nervous women and children, and as a carminative in indi- 
viduals who suffer from intestinal flatulence. It is of value in nervous 
dysmenorrhea and headache, and is best combined with one of the new 
analgesics, such as antipyrin and acetanilid given in tablet-form. As 
it is virtually a volatile oil so far as its physiological action is con- 
cerned, it will be found useful in cholera and in cholera morbus, and 
in all forms of serous diarrhea, but rarely in mucous diarrhoea. (See 
Diarrhoea.) In chordee, combined with bromides and similar depress- 
ants to the spinal cord, camphor is of great service in some cases, 
particularly late in the disease. In adynamic fevers it has been used as 
a diffusible stimulant by Graves and by many others since his time with 
success. Camphor is a very useful remedy in sudden nervous depression 
coming on in the course of acute or prolonged exhausting diseases. 
It may be given by the mouth or, if the emergency is a pressing one, 
by hypodermic injection. Under these circumstances it is best given 
in the form of camphorated oil in the strength of 1 part of camphor 
to 9 of sweet oil, which last should be perfectly sterile. The dose of 
this solution is 15 minims (1.0). When used in the nervous depression 
of phthisis, Alexander asserts that its continuous injection may result 
in cumulative action and develop the symptoms of mild camphor 
poisoning. In hiccough it is of great service, and in cardiac palpitation 
due to functional irritability it is of value. In old or atonic cases of 
capillary bronchitis and catarrh of the air-passages it is useful. In 
chronic nasal catarrh spirit of camphor when inhaled from the mouth 
of a vial gives off enough of the drug to stimulate secretion and tone 
up the parts. It is also of value as a mouth-wash in persons who 
have fetid breath. 

Camphor may be inhaled or taken internally in cases of cold in 
the head, in the early stages, with great relief, and exercises a decided 
influence in aborting the attack. The following formula may be 
employed : 

Be — Camphorae gr. ij (0.12). 

Fluidextract. belladonnas .... TTLjss (0.08). 
Quininae sulph gr. ij (0.12). — M. 

Ft. tabellae No. x. 

S. — One every hour for lour or five doses. 



CAMPHOR MONOBROMATE. 143 

After the attack is well developed this is useless, but used early it will 
decrease the frontal headache and the sneezing and running at the 
nose. In coryza from unknown causes with much lachrymation and 
incessant sneezing, camphor will be found of benefit. It may be 
snuffed up the nostril in a fine powder, or powdered camphor may be 
put in boiling water and the fumes inhaled. The spirit may also be 
inhaled from a handkerchief. 

External Use. — Externally camphor may be used as a stimulant 
to indolent sores and as a useful addition in small amount to the pre- 
cipitated carbonate of calcium as a dusting-powder in intertrigo. In 
the form of a liniment camphor is used over inflamed joints from 
sprains or rheumatism, and in myalgia and neuralgia to relieve the 
pain and stiffness. 

Camphorated alcohol, spirit of camphor, is a useful application for 
abortive purposes when used over boils in their early stages, if repeated 
two or three times a day for a few moments at a time. Following these 
applications, the skin should be dried and camphorated oil applied. 
Ringer and Tilt recommend that Eau de Cologne, saturated with 
camphor, be rubbed into the scalp in the drowsiness and headache of 
the menopause, and a lotion of equal parts of aqua ammonia and spirit 
of camphor dabbed on the painful or hyperaesthetic spots at the top of 
the head, so commonly felt by nervous women at the change of life or 
during menstruation, will be found to give relief. 

Administration. — Camphor is used internally in the form of the 
camphor-water (Aqua Camphors, U. S. and B. P.), dose i to 2 fluid- 
ounces (16.0-60.0) ; the spirit of camphor (Spiritus Camphors, U. S. 
and B. P.), dose J fluidrachm (2.0), or in the form of the camphor 
itself, in pill, in the dose of 1 to 3 grains (0.06-0.20) in each pill. 

The best preparation for internal use is the spirit, or the gum cam- 
phor itself may be given. 

For external use we have, official, camphor liniment (Lini- 
mentum Camphors, U. S. and B. P.) and soap liniment, or Lini- 
mentum Saponis, U. S. and B. P., which is the milder of the two. 
Ceratum C amphora? is also official. A compound tincture of camphor 
(Tinctura C amphora? Composita), composed of opium, benzoic acid, 
camphor, and oil of anise, is official in the B. P., dose 15 minims 
to 1 fluidrachm (1.0-4.0). This preparation is practically equivalent 
to ''paregoric." Linimentum Camphora? Ammoniatum, B. P., is com- 
posed of camphor, rectified spirit, and stronger ammonia. 

CAMPHOR MONOBROMATE. 

Monobromated Camphor (C amphora monobromata, U. S.) is made 
by heating together in a sealed tube camphor and bromine. It occurs 
in colorless crystals or scales, and has a mild taste resembling camphor. 
It is almost entirely insoluble in water, but is freely soluble in alcohol, 
ether, and chloroform. 



144 DRUGS. 

Physiological Action. — Monobromated camphor possesses powers 
partaking of the bromides and of camphor. In the frog it causes loss 
of reflex action, motor palsy and death by respiratory failure, and in 
warm-blooded animals violent convulsions, Cheyne-Stokes respirations, 
muscular tremblings, and weakness. The pulse is at first more rapid 
than normal, then slow and weak, death ensuing in coma or during 
the convulsions. 

Therapeutics. — When combined with other drugs monobromated 
camphor will generally be found most useful for pain, particularly in 
lumbago, or ths pain due to nervous disturbances. If used in hysterical 
females, it will often produce sleep, and is of value to those who are 
addicted to the alcohol-habit, as it acts as a hypnotic and warms 
the stomach. Like camphor itself, it is a gastric irritant, and should 
not be employed where gastritis exists. It has been used in sperma- 
torrhoea with great success, and in delirium tremens has been found 
of benefit in cases where the gastric mucous membrane is depressed 
and the nervous twitchings are troublesome. In ivhooping -cough it 
may be tried, and it has been used in chorea, epilepsy, and petit 
mal. In the nervous depression and pains of epidemic influenza 
monobromated camphor has been largely used. (See Acetanilid.) 

Administration. — This drug should never be used hypodermically, 
as it is too irritating, but administered in the dose of 5 grains (0.32) 
three times a day in pill, or in an emulsion made by dissolving it in 
six times its weight of expressed oil of almonds and then forming an 
emulsion with gum-arabic water in the usual manner. 

CAMPHORIC ACID. 

Camphoric Acid (U. S.), made by the oxidation of camphor through 
the influence of acids, is the best remedy for the night-sweats of phthisis. 
In a large number of cases suffering from night-sweats the author has 
found this drug to act very favorably indeed where other remedies 
failed, and he has never seen it produce disagreeable symptoms. 

It may be given in the dose of from 20 to 30 grains (1.3-2.0), 
taken an hour or two before the sweat is expected. In very obstinate 
cases as much as 60 grains (4.0) should be given, but under these cir- 
cumstances it should be used in two separate doses of 30 grains (2.0) 
each, two hours apart, in order to avoid irritating the stomach. It is 
best given in capsule or cachet, as it is insoluble in water. In other 
instances camphoric acid may be given in the following formula: 

1$ — Acid, camphoric oiv (16.0). 

Alcohol. - . "fgij (60.0). 

Mucilag. acaciae f5iij (90.0). 

Syr. aurantii corticis q.s. ad fgvj (180.0) .— M. 

S. — Dessertspoonful (8.0) to a tablespoonful (16.0) one hour before sweat is 
expected. 

In the writer's experience, it is worthy of note that camphoric acid 
is possessed of little power in cases of bromidrosis. 



CANNABIS INDICA. 145 



CANNABIS INDIGA. 



Indian Hemp (Cannabis Indica, U. S. and B. P.) is the flowering 
tops of the female plant of Cannabis sativa. It is to be distinctly 
separated from the so-called American, American-Indian, or Canada 
hemp, or Apocynum Cannabinum, which in full doses is an intense 
irritant and drastic. 

The selection of this drug is attended with peculiar difficulties 
because of the fact that only the non-fertilized female flower-spikes are 
possessed of therapeutic activity, the male spikes and female flower- 
tops which are bearing seed being inert. The three varieties resemble 
one another so closely that when crushed and intimately mixed in a 
bale it is practically impossible for even a drug expert to distinguish the 
active from the inert part of the plant. 

Physiological Action. — Given in full dose to man, this drug causes 
exhilaration and incessant laughter arising from the slightest cause, 
the person seeming convulsed with merriment; in other cases the 
sensations are disagreeable, and even death may seem imminent to 
the deranged mind. Sometimes the sensation of very full breathing 
comes on, and the patient thinks he is about to burst from the inflation 
of his lungs. After this, deep sleep ensues, lasting for many hours, 
even as many as fourteen or fifteen, without intervals of wake- 
fulness. One of the most constant and marked symptoms in 
poisoning in man is the sensation of prolongation of .time, so that 
minutes seem like hours, and, in addition to this, a peculiar separation 
of the mental powers occurs, during which both hemispheres of the 
brain seem to think differently on the same subject. If the dose be 
very large, the respirations are slowed very considerably, but no death 
from the use of cannabis indica by man is on record, and enormous 
amounts have been given to the lower animals without causing a lethal 
effect. 1 Applied to mucous membrane, it acts as a severe irritant, 
and then as a local anaesthetic, but the primary effect is so powerful 
as to prevent its application to mucous membranes for the relief of 
pain. 

Therapeutics. — Cannabis indica is one of the best additions to 
cough mixtures that we possess, as it quiets the tickling in the throat, 
and yet does not constipate nor depress the system as does morphine. 
In advanced phthisis it is justifiable to keep the patient constantly in a 
state of quiet comfort by its use. For the relief of pain, particularly that 
depending on nerve-disturbance, hemp is very valuable. Before the 
introduction of antipyrin and its congeners, tincture of gelsemium and 
the tincture or extract of cannabis indica were our best remedies in 
the treatment of migraine. The gelsemium in such cases should be 
given in full dose, 20 drops (1.3) of the tincture, and be followed by 

1 The author has injected as much as 5 drachms of a fluid extract, active in the dose, of 10 
minims to man, into the jugular vein of a small dog without producing death for many hours, 

10 



146 DRUGS. 

10 to 20 drops (0.60-1.3) of the fluid extract of cannabis indica, it 
being known that the sample about to be used is active. After this 
dose of gelsemium the patient should be carefully watched, lest he 
suffer from an excessive influence of the drug, as such an amount 
may produce great depression in susceptible persons. In true migraine 
with hemianopsia this treatment is often most effectual in aborting 
the attack. The prevention of further attacks is to be attained by the 
use of smaller amounts of the cannabis indica during the intervals, 
the gelsemium only being used at the onset of the symptoms. In 
paralysis agitans cannabis indica may be used to quiet the tremors, 
and in spasm of the bladder, due to cystitis or nervousness, it often 
gives great relief. In sexual impotence, not dependent upon organic 
disease, it is said to be of value combined with strychnine or nux 
vomica and ergot. 

In headaches at the menopause cannabis indica is useful, and if the 
headaches are associated with constipation and anaemia, iron and aloes 
should be given simultaneously. Where headaches are due to retinal 
asthenopia a very useful prescription, according to de Schweinitz, is 
as follows: 

1$ — Tr. nucis vomicae f5ij (8.0). 

Tr. cannabis indicse f 3ij (8.0). — M. 

S. — 15 drops (1.0), in water, twice or thrice a day. 

The following prescription has been found to be very efficient in the 
hands of the author in treating gastralgia and other forms of abdominal 
pain : 

R— Tr. capsici f.^j (4.0). 

Tr. cannabis ind f.^ss(16.0). 

Tr. opii deodorati f §j (30.0). 

Spt. chloroformi f|j(30.0). 

Tr. lavandul. comp. . . . q. s. ad f^iv (120.0). — M. 
S. — Teaspoonful (4.0) every hour until pain is relieved. 

In cases of uterine subinvolution, chronic inflammation, and irrita- 
tion cannabis indica is of great value, and it has been found of service 
in metrorrhagia and nervous and spasmodic dysmenorrhea. Not only 
does it relieve the pain, but it also seems to act favorably upon the mus- 
cular fibres of the uterus. 

In acute and chronic Brighfs disease cannabis indica often allays 
the painful sensations over the renal region, and has been recom- 
mended by some writers in the cases in which bloody urine is present. 
In gonorrhea it is said to decrease the discharge and prevent chordee, 
and it has supplanted the use of copaiba and cubebs in some practi- 
tioners' hands. It should not be used in the early stages of gonor- 
rhoea, but in the later or subacute stages. There is some foundation 
for the belief that in small doses it acts as a sexual stimulant. 

The advantages possessed by cannabis indica are that it does not 
constipate nor cause after-depression and nausea. On the contrary, 
there is often an increase rather than a decrease of the appetite under 



CANTHABIS. 147 

its influence. In the Anglo-Saxon race the cannabis indica habit is 
practically unknown, but in the East Indies when used to excess it 
sometimes causes maniacal insanity, from which the patient nearly 
always recovers after some days, weeks, or months. 

Administration.— The employment of this most valuable remedy is 
handicapped by its frequent lack of power — a fault which is largely 
dependent upon reasons already given. Only a preparation which has 
been physiologically tested should be used. The drug as prepared by 
Parke, Davis & Co. has proved efficacious in the author's hands for a 
number of years. The physician should always employ some prepa- 
ration known by him to be active by personal trial before condemning 
the drug as a failure in a given case. 

The dose of the solid extract (Extraction Cannabis Indicw, U. S. 
and B. P.) is from \ to \ grain (0.015-0.03), that of the fluid extract 
(Fluidextractum Cannabis Indica;, U. S.) from 4 to 20 minims (0.25- 
1.3) and that of the tincture (Tinctura Cannabis Indica?, U. S. and 
B. P.) from 15 minims to 1 drachm (1.0-4.0). 

CANTHARIS. 

Cantharis (U. S. and B. P.), or " Spanish Fly," is really a beetle, 
known as Cantharis vesicatoria, and as such appears with iridescent 
coverings or wing-sheaths of a bluish or greenish hue. The insects 
come chiefly from Spain, Italy, and Sicily, and from the southern parts 
of Russia. Those from Russia are supposed to be the best. Accord- 
ing to Leidy, the vesicating substance is in the blood, the eggs, and the 
secretions of the generative apparatus. The blistering substance 
contains cantharidin as an active principle, but cantharidin is not 
medicinally employed. 

Physiological Action. — Locally applied to the skin, cantharides causes 
irritation and finally vesication. The blister produced may be quite 
large, and enough of the drug may be absorbed to cause fever and 
nervous excitement. The ingestion of a moderate dose of cantharides 
produces a sensation of warmth in the stomach and slight stimulation 
of the genito-urinary system, particularly the kidneys and urinary 
tracts. Large amounts produce great pain in the lumbar region, a sen- 
sation of heat in the bladder and the urethra, priapism, agonizing 
vesical tenesmus, widespread acute nephritis, bloody urine, which is 
scanty at first, and finally suppressed, with great irritation of the exter- 
nal openings of the genito-urinary apparatus. The inflammatory 
changes may cause sloughing of the penis or of the labia in the 
female. 

Violent gastro-enteritis is nearly always a pressing condition. A 
diagnostic sign of cantharidal poisoning, when the beetles have been 
swallowed, is the appearance of pieces of the iridescent wing-sheaths 
or coats in the vomit. Thirst is always a prominent symptom of 
poisoning by cantharides. 



148 DRUGS. 

Therapeutics.— Can tharides are employed internally and externally. 
When given by the mouth the tincture is used as a uterine stimulant, to 
affect the uterine mucous membrane and relieve amenorrhea in cases 
in which atony and depression are the cause of the depression. Some 
persons teach that the tincture of cantharides is a valuable remedy in 
small doses in the second stage of acute desquamative nephritis, but in 
the instances where the writer has seen it used it has aggravated the 
condition, although it is supposed to decrease the excretion of the 
albumin and blood. In the later stages, where the kidneys are relaxed 
and torpid or where albuminuria comes on on the slightest exertion, 
tincture of cantharides in the dose of i minim (0.025) three times a day 
is of service. 

In cases of chronic parenchymatous nephritis, particularly where 
alcoholism is the cause of the disease and the kidneys are inactive, can- 
tharidal tincture is very useful. In pyelitis and in chronic cystitis it is 
of service, and it has been recommended highly in drop doses in 
irritability of the bladder in women and children. In these cases the 
bladder must not be inflamed, but irritable from depression. The use 
of cantharides is of value in incontinence of urine of a minor degree, 
as that occurring in elderly or nervous females when coughing, 
sneezing, or laughing, and will often give relief after years of suf- 
fering. In chordee, in the dose of J minim (0.025) twice or thrice 
daily, it is sometimes of service. For impotence depending upon sexual 
excess Ringer asserts that the use of 5 to 8 minims (0.30-0.50) of 
the tincture of cantharides, with full doses of the tincture of the chlo- 
ride of iron and nux vomica, will often relieve the patient and enable 
him to beget children. This dose of cantharides must be given with 
caution. The drug has no true aphrodisiac influence except when 
given in almost toxic dose. In gleet of a very chronic type and in 
prostatorrhwa it is of service. Dermatologists have used cantharides 
internally as a remedy in psoriasis, eczema, lichen, and prurigo, with 
asserted great success. The dose should not be large enough to irritate 
the stomach or kidneys. 

Externally, cantharides are used in the production of blisters for 
the purpose of causing the absorption of effusions or as a counter- 
irritant of some severity in cases of deep-seated inflammations. (See 
Counterirritation.) Care should be taken that a sufficient amount of 
the drug is not absorbed to cause strangury and renal irritation. In 
renal congestions and inflammations the use of cantharides as a counter- 
irritant is often contraindicated because of this danger. Huchard and 
others have reported cases in which, without disease of the kidney, 
a cantharidal blister has produced violent acute nephritis, with result- 
ing uraemia. In the proportion of J minim (0.025) of the tincture of 
cantharides to 40 (2.6) of water it is said to be an efficient application 
for burns, but how it acts is not known. 

Administration. — The dose of the tincture (Tinctura Cantharidis, 
U. S. and B. P.) is from J to 5 minims (0.025-0.30), and it is the only 



CAPSICUM. 149 

preparation used internally. The cerate (Ceratum Cantharidis, U. S.) 
is used, spread upon muslin, to produce a blister, and the cerate of the 
extract, which is no longer official, is used for the same purposes and in 
the same manner. The cantharidal collodion (Collodium Cantharida- 
tum, U. S.; Collodium Vesicans, B. P.) is a method of applying the 
blister which is most cleanly, but there is more danger of absorption of 
the drug if it is used. The collodion acts as a protective to the part. 
Liquor Epispasticus, B. P., is employed as a counterirritant. 

" Warming plaster " (Emplastrum Picis Canthari datum) is a mild 
counterirritant plaster to be employed where a blister is thought 
to be too severe. The preparations of the B. P., other than those 
named, are Emplastrum Cantharidis and Unguentum Cantharidis. 

The unofficial plasters of cantharides are the best preparations to 
use for the production of a blister. In order to obtain a perfect 
effect the skin should be washed thoroughly with soap and water 
and dried with a towel, which should be rough enough to produce 
reddening of the cuticle. After this the skin should be moistened 
with vinegar, and while wet the blister is to be applied. 



CAPSICUM. 

Capsicum, U. S., Capsici Fructus, B. P., or Cayenne Pepper, is the 
fruit of Capsicum jastigiatum or minimum, a native of tropical Africa 
and of Central America. It occurs in long, ovoid pods, which, when 
ripe, are scarlet red and possess a very hot, burning taste. The active 
principle is capsicine, which is a dark reddish liquid, and which is a 
volatile alkaloid. 

Physiological Action. — Locally applied to the skin or mucous mem- 
branes capsicum causes redness, and finally, in the case of mucous 
membranes, vesication. The alkaloid will also produce these changes 
in the skin. When used internally for any length of time in ex- 
cess capsicum will cause a chronic or subacute gastritis with pain 
and discomfort over the liver and stomach. If single large doses are 
used, renal irritation and inflammation ensue, with strangury and the 
passage of concentrated urine. Taken internally, capsicum is said to 
act as a circulatory stimulant. 

Therapeutics. — In cases of atony of the stomach due to general 
debility, errors in diet, and alcoholism of the chronic type capsicum is 
one of the best remedies we have. When the patient is suffering from 
acute alcoholism the gastric mucous membrane is often too much irri- 
tated to permit of its use, but after the lapse of some days it may be 
found of benefit for the purpose of increasing the digestive power. 
As a remedy for subacute alcoholism it is useful, since by its stimulating 
effect and hot sensation it often satisfies, at least to some degree, the 
craving for alcohol. Under these circumstances it should be used in 
the dose of 3 to 5 minims (0.20-0.30) of the tincture every four or five 



150 DBUGS. 

hours, or as the oleoresin in pill in the dose of \ to 1 grain (0.03-0.06). 
The following prescription has been found of great service in these 
cases : 

fy — Tr. capsici f^iss (6.0). 

Tr. opii deodorat foij (8.0). 

Spt. aether, nitrosi f 3iv (15.0). 

Tr. lavandulse comp q. s. ad fgiv (120.0). — M. 

S. — Dessertspoonful (8.0) every four or five hours. 

In the flatulent colic of old persons and young adults capsicum will be 
found not only to act as a carminative, but also to prevent the develop- 
ment of the gas. In low fevers it has been used as a diffusible stimulant, 
but it is of doubtful value. It is rather in the anorexia of convalescence 
that capsicum acts most favorably. In chronic nephritis it is of con- 
siderable service, and it tends to check albuminuria, but it is only to be 
used in the chronic forms and stages of renal disease or in the treatment 
of functional torpidity of the kidney. The tincture is to be given under 
these circumstances in the dose of 10 minims (0.60) or less, but in some 
cases which are very chronic as much as 20 minims (1.3) may be used. 
In sore throat and simple tonsillitis the tincture of capsicum and glycerin, 
half and half, form a very useful local application applied by means of a 
swab. The same preparation may be used as a gargle for relaxed uvula 
and sore throat. 

Capsicum may be used as a gastro-intestinal stimulant to aid in the 
absorption of other drugs. Applied externally, capsicum acts as a 
counterirritant, producing redness of the skin, but not a blister in the 
ordinary individual. It is one of the best moderate counterirritants 
which can be used, and it may be employed by repeatedly saturating 
blotting-paper in the tincture of capsicum, allowing the paper to dry 
between each dip. This paper should finally be placed when warm 
and wet over the part, and held closely to the skin by a compress. 
Capsicum plaster (Emplastrum Capsici, U. S.) is useful in lumbago and 
rheumatism when placed over the affected muscles, and in headache 
when applied to the nape of the neck. The tincture is sometimes 
painted over chilblains which are unbroken. The following method, 
given by Ringer, is very efficacious in this annoying affection: 

"Make a strong tincture of capsicum-pods by steeping them for 
several days in a warm place in twice their weight of rectified spirit of 
wine. Dissolve gum arabic in water to about the consistence of treacle. 
Add to this an equal quantity of the tincture, stirring together with a 
small brush or a large camel's-hair pencil until they are well incor- 
porated. The mixture will be cloudy and opaque. Take sheets of silk 
or tissue-paper; give them, with the brush, a coat of the mixture; let 
them dry, and then give another coat. Let that dry, and if the surface is 
shining, there is enough of the peppered gum; if not, give a third coat. 
This paper should be applied in the same way as court-plaster to chil- 
blains that are not broken and burns that are not blistered, and it will 
speedily relieve the itching and pain. It acts like a charm and effects 



CARBOLIC ACID. 151 

a rapid cure. The same is true of discolored bruises. It likewise 
allays rheumatic pains in the joints."' 

The dose of capsicum is 1 to 2 grains (0.06-0.12) in powder, on 
food or in pill. The dose of the tincture of capsicum (Tinctura Capsici, 
U. S. and B. P.) is 5 to 10 minims (0.30-0.60), and of the oleoresin 
(Oleoresina Capsici, U. S.) J to J minim (0.015-0.025). The dose of 
the fluid extract (Extraction Capsici Fluidum, U. S.) is 1 to 3 minims 
(0.05-0.20). The plaster (Emplastrum Capsici, U. S.) is useful for 
external applications. An ointment (Unguentum Capsici) is official in 
the B. P. 

CARBOLIC ACID. 

Carbolic Acid (Phenol, U. S., and Acidum Carbolicum, B. P.) is also 
known as Phenylic Alcohol and Phenic Acid. Not only is it an acid, 
but in addition it is an alcohol of the peculiar group known as the 
phenols, which are derived from coal-tar by a process of distillation. 
Its acidity is, however, very feeble. 

Phenol is sold in several grades, No. 1 being the purest. Both 
Nos. 1 and 2 are crystalline, while Nos. 3, 4, and 5 are impure because 
of the presence of cresylic acid and other foreign substances. Only 
No. 1 should be ordered when phenol is to be given by the mouth. 

Phenol has a characteristic odor, and varies in color according to its 
method of preparation and purity. It is soluble in 20 parts, of 
water, but it is liquefied by the addition of 8 per cent, of water. 
Phenol should be kept in dark amber-colored, well-stoppered bottles. 

If the crystals be exposed to the air, they undergo liquefaction, 
and in consequence the purest phenol is usually prescribed in minim 
doses rather than in grains. It is soluble in alcohol, ether, chloroform, 
glycerin, and most oils. It unites with alkalin bases to form salts, 
carbolates; but these are readily decomposed, even by the feeblest 
acids, such as carbonic acid. 

Physiological Action. — Locally applied to the skin, phenol produces 
at first a burning sensation, accompanied by a diffuse reddening of 
the surface. If the solution be strong, the part at once becomes tem- 
porarily painful, then bleached and numb, so that tactile sensibility is 
destroyed. Applied to mucous membranes, it causes similar changes, 
but to a more marked degree, and may even act as a moderately severe 
caustic of a superficial type. Owing to the coagulation of albumin pro- 
duced when it is applied, it cannot cauterize the tissues very deeply. 

Nervous System. — Phenol acts as a depressant and paralyzant 
to the peripheral sensory nerves when locally applied. Upon the 
higher centres in the brain the acid produces a condition of depression 
and stupor. 

The convulsions which sometimes occur after toxic doses have been 
taken are spinal in origin, as they occur after section of the spinal 
cord. The motor nerves escape almost untouched, as do also the 
muscles. 



152 PBUGS. 

Circulation. — Upon the circulation in the higher animals the drug 
exercises a distinct depressant influence, stopping the heart in diastole 
in lethal dose, and paralyzing the vasomotor centre even before the car- 
diac muscle is affected. These changes follow only lethal doses. Small 
medicinal doses have no effect of any moment upon the circulation. 

Respiration. — After large doses the breathing becomes more rapid 
and full. These changes, according to Salkowski and others, are due to 
stimulation of the respiratory centres and the peripheral vagi. Lethal 
doses almost invariably kill by failure of respiration due to depression 
of the respiratory centres. 

Temperature. — Phenol acts as a feeble depressant to normal 
bodily temperature even when given in medicinal dose, and also 
decreases the bodily heat in fever. It lowers fever by diminishing heat- 
production and inc. easing heat-dissipation. This antipyretic power is 
hardly sufficient to permit of its use in disease for this purpose. 

Kidneys and Elimination. — When phenol is given in overdose, 
the kidneys may become so irritated that total urinary depression 
may occur. When taken in large quantity, it causes the urine to 
become brownish -black. This discoloration is due to an educt of 
phenol which is not yet isolated, perhaps hydrochinon. Phenol is 
eliminated in the urine as a sulphocarbolate of sodium and potassium 
and as glyco-uronic acid and hydrochinon. Part of it is burnt up 
in the body. 

It is to be distinctly understood that the dark urine of phenol 
poisoning is not due to the presence of blood or of any of its educts. 

Poisoning, Prolonged and Acute. — As the changes produced in. the 
tissues of the body by acute and subacute poisoning by phenol are 
in many respects identical, they may be considered together. 

Phenol is one of the most deadly and rapidly acting poisons 
known, although this fact does not seem to be generally recognized. If 
a large lethal dose be swallowed by a man, he may drop dead from its 
effects before he can go more than a few feet from the spot where he 
stood when drinking the drug, or he may live a few hours. In cases 
where death has occurred suddenly from taking this acid the direct 
cause has been failure of respiration. If the patient does not die at 
once, all the evidences of gastro-enteritis come on. Violent vomiting 
and purging may ensue, and burning pain in the entire abdomen is a 
prominent symptom. The skin is wet with sweat, the face pinched and 
anxious. Collapse, with a thready, imperceptible pulse and extreme 
dyspnoea, may be present. The mouth and lips may not smell of the 
drug, but the mucous membrane will be seen to be corrugated and 
stained black if impure acid has been taken, or be whitish if the pure 
drug has been used. The eschar on the mucous membrane is a peculiar 
one, and is pathognomonic of the poison, having a white centre sur- 
rounded by a reddened and inflamed zone, the centre sometimes becom- 
ing dark brown or black. The post-mortem will show these spots in 
the oesophagus and stomach, and even in the intestines. All the inter- 



CARBOLIC ACID. 153 

nal organs, as the brain, kidneys, liver, and spleen, will be found filled 
with dark grumous blood, and on opening the body the odor of 
the acid will be perceived. A peculiar croupous exudate is sometimes 
found in the bronchial tubes, and fatty degeneration of a more or 
less widespread type often follows phenol poisoning. Langerhans 
has noted that in some of these cases evidences of croupous pneumonia 
exist. A very common symptom is hoarseness of the voice due to an 
effect on the larynx after the drug is absorbed, and not from its local 
influence. 

A large number of cases are on record in which subacute carbolic-acid 
poisoning has been produced by its absorption from surgical dressings. 
The earliest signs of such an accident are the darkened, smoky hue of 
the urine and slight nervous unrest or cerebral disturbance. Very 
often pain in the lumbar region indicates kidney irritation. The 
dressings should be, of course, at once removed. 

Treatment of Poisoning. — The chemical antidotes to phenol 
are the soluble sulphates, such as Epsom or Glauber salt, which form 
insoluble sulphocarbolates, and which are preferable to other soluble 
sulphates in that they also act as purgatives if freely used, and so wash 
out the bowel. The further treatment consists in the administration 
of warm mucilaginous drinks, hot applications to the extremities, 
the hypodermic injection of cardiac and respiratory stimulants, such 
as digitalis and strychnine, morphine to relieve pain, and the use of 
counterirritation over the abdomen. Emetics and the stomach-pump 
should be used if possible, but the former are generally useless because 
of tjie state of the stomach. 

When phenol has been spilled on the hands, its effects can be over- 
come if the hands are immersed at once in absolute alcohol. There 
is no satisfactory explanation of this extraordinary effect. Alcohol 
may also be used internally as an antidote; but as it cannot be 
taken in concentrated form, its internal use is not of much value in 
this condition. 

Therapeutics. — Internally phenol is little used, but, nevertheless, 
has a very favorable effect in certain states. In nervous vomiting or 
in that due to gastric irritation the drug does good in \ to 2 minims 
(0.025-0.10) doses by depressing the sensory nerves in the stomach. 

In diarrhcea depending upon fermentation from 2 to 4 minims 
(0.10-0.25) of the acid do great good, particularly if combined with 10 
to 20 grains (0.60-1.30) of bismuth administered in powder or capsule. 

In gangrene and tuberculosis of the lung a spray of the acid in water 
in the strength of 5 to 15 minims (0.3-1.0) to the ounce (30.0) may do 
some good, and at least control the cough and relieve the irritation and 
tickling in the throat. 1 (See Part III., Inhalations.) Creosote is, how- 
ever, generally preferred in these conditions at the present time. 



1 The spray must be a very fine one, or it will not carry the drug far enough down into the lungs 
to be efficacious. 



154 DRUGS. 

In diphtheria, ulcerated sore throat, and even in ordinary stomatitis, 
phenol will be found of value when used in a spray or mouth-wash in 
the proportion of 1 part to 75 parts of water; and in ordinary sore 
throat or that due to sepsis, in the strength of 1 part to 100 of water it 
will be found, when applied on a swab or by a gargle, to relieve the 
pain and inflammation. By means of a stick it may be applied pure 
to the spots in aphthous stomatitis. In the treatment of burns phenol- 
ized sweet oil in the proportion of 1 drachm (4.0) of the drug to each 
6 ounces (180.0) makes one of the best dressings that can be used. By 
means of the local anaesthesia produced by the drug, minor operations, 
such as eversion of an ingrowing toe-nail or opening a felon, may be 
performed by applying the pure drug by means of a brush to the line 
of the incision. Phenol may be used as a lotion in the itching of jaun- 
dice in the proportion of 10 grains (0.60) of the drug to 2 drachms (8.0) 
of glycerin and 2 drachms (8.0) of water, or, better still, 4 drachms 
(16.0) of sweet oil. 

In the form of an ointment phenol may be used in the strength of 
10 minims to the ounce (0.60-30.0) of a simple cerate, particularly in 
cases of subacute eczema where there is a great amount of weeping. 
In cases of eczema with much itching, and in pruritus and lichen planus, 
the following ointment is useful : 

R— Menthol gr. v (0.30). 

Phenol gr. x (0.60). 

Ung. aquse rosse . %] (30.0). — M. 

S. — Apply locally. 

Several clinicians have recommended the treatment of smallpox by 
touching the vesicles in limited areas each day with a small brush or a 
stick dipped in the pure drug. It is claimed that in this way pustulation 
is decreased, secondary fever is diminished, and pitting is lessened. 

In enlarged glands which have not gone on to suppuration intra- 
glandular injections of phenol by means of a hypodermic needle are 
of value in a large number of cases, the solution used being no weaker 
or stronger than 2 per cent.; 5 to 10 minims (0.30-0.60) of this solution 
are sufficient for each gland. In the treatment of buboes 10 minims (0.6) 
of a solution of 8 grains (0.5) to the ounce (30.0) may be injected into 
the swelling, the skin being first benumbed by an ether spray. This is 
the most successful treatment. The same treatment may be applied 
in chronic synovitis and repeated every three days, and boils and car- 
buncles may also be so treated with great success if the measure be used 
early enough to abort the trouble. 

Phenol is rarely used directly over wounds in dressings at present 
unless the dressing be one of carbolized oil. Other drugs or rigid 
asepsis have supplanted it when used in this way, but surgeons have 
returned to its employment as a useful antiseptic when used in pure 
form to swab out open wounds that are infected. The use of the phe- 
nolized spray over wounds has been found to do more harm than good, 
and it ought never to be employed. 



PLATE II. 





PHENOL GANGRENE. 



Appearance of a finger four weeks after the appli- 
cation for twenty-four hours of a dilute solution of 
phenol. The finger was wrapped in cloths which were 
saturated with the carbolic solution not stronger than 
five per cent. Amputation necessary. Inflammatory 
process at the base of the finger shown by the reddened 
tissues. (Harrington's ease.) 



CARBON {CHARCOAL). 155 

As a disinfectant phenol ranks among the poorest: 1 to 2 per cent, 
solutions, however, kill most spores and germs. 

Untoward Effects. — Phenol when applied as a dressing, even in as 
weak a strength as 3 per cent., to a finger or toe may cause gangrene 
of the part severe enough to destroy it or to require amputation. Such 
strengths applied to the skin of the trunk rarely produce evil effects, 
probably because the circulation is not so completely cut off by the 
action of the drug on the bloodvessels. (See Plate I.) 

Administration. — Phenol ointment (Unguentum Phenolis, U. S.; Un- 
guentum Acidi Carbolici, B. P.) and the glycerite (Glyceritum Phenolis, 
U. S.) and liquefied phenol (Phenol Liquefactum, U. S.) are the only 
official preparations of phenol in the U. S. P. In the B. P. the follow- 
ing preparations are official : Acidum Carbolicum Liquefactum, given in 
the dose of 1 to 2 minims (0.05-0.10); Glycerinum Acidi Carbolici, 
Trochiscus Acidi Carbolici, and Suppositorium Acidi Carbolici. 

CARBON (CHARCOAL). 

Carbo Ligni,]]. S. and B. P., or Charcoal, is prepared by the exposure 
of soft wood to a red heat, air being prevented from coming in contact 
with the wood during the process. Charcoal when used for medicinal 
purposes should be a black, brittle, somewhat shiny, porous substance, 
devoid of taste and odor, and completely insoluble in water. 

Therapeutics. — Charcoal is used externally as an application to old 
sores or sloughs to act as a deodorant and antiseptic. These things it 
accomplishes by the absorption of any liquids which may be present, 
thereby depriving germs of a nidus, and by its distinct oxidizing power. 
It may be applied in the form of a dry powder or in a poultice, which is, 
however, so uncleanly that other antiseptic dressings are preferable. 

The poultice (Cataplasma Carbonis), if used, should be made in the 
following manner: Take of powdered wood-charcoal \ ounce (16.0), 
bread-crumbs 2 ounces (60.0), linseed meal \\ ounces (45.0), and add 
boiling water 10 fluidounces (300.0). Macerate the bread-crumbs and 
meal for ten minutes over a fire, and then stir in the charcoal to the 
extent of half the amount just named. Spread out the poultice and 
sprinkle the remaining half of the charcoal over its surface, and apply 
while hot to the part affected. 

Internally, charcoal is used in powder in many conditions, and acts 
very well indeed in cases of so-called "sour stomach' " from which 
eructations of gas or sour liquids take place. 

The following prescription will also be found useful in the atonic or 
subacute gastric catarrh of persons who are careless in eating and who 
have much belching: 

Py — Oleoresin. capsici gtt. x vel xx (0.60-1.3). 

Pancreatin. . . . . . . . . gr. xx (1.3). 

Pulv. zingiberis gr. xl (2.6). 

Pulv. carbon, ligni gr. x! (2.6). — M. 

Ft. in pil. No. xx. 
S. — One or two t. i. d. 



156 DRUGS. 

As ordinary charcoal is not always obtainable, it may be substi- 
tuted by pieces of very thin toast burnt through and through till they 
resemble charcoal. If the attack is very severe and vomiting eventu- 
ally ensues, the ejecta will commonly be found to be odorless and not 
sour, and the stools will also be almost odorless, though black. In 
fermentative and acid diarrheas in adults this method of treatment 
is often of value, the prescription given above being a valuable means 
of cure. When charcoal is used in any condition associated with 
irritation of the mucous membranes of the gastro-intestinal tract, it 
should always be very finely pulverized, and if the stomach or bowels 
are inflamed the capsicum must be excluded from the prescription. 

As a filter for impure water, charcoal, in mass or in powder, is one 
of the most satisfactory substances we have. 

CARDAMOM. 

Cardamom (Cardamomum, U. S.) is the fruit of Elettaria Repens, 
and is a bitter tonic possessing some aromatic properties. It is useful 
in cases of atony of the stomach and small intestine, particularly if com- 
bined with a mineral acid or some other bitter tonic, such as gentian. 
Cardamom is official in the B. P. as Cardamomi Semina. 

If the intestine is atonic and secretion is deficient, the following 
prescription will be found of value: 

If- Acid, nitric, dil. f 3j (4.0). 

Tr. cardamomi comp q. s. ad f §vj (180.0). — M. 

S. — Dessertspoonful (8.0) after each meal. 1 

Administration. — The official preparations of cardamoms are the 
tincture of cardamoms (Tinctura Cardomomi, U. S.), dose 1 to 2 
drachms (4.0-8.0) ; and the compound tincture ( Tinctura Cardomomi 
Composita, U. S. and B. P.), which is to be given in the same dose 
as the tincture. This tincture also contains cochineal, cinnamon, 
caraway, and glycerin. Cardamom is also a constituent of the official 
aromatic powder (Pulvis Aromaticus, U. S.). 

GASCARA SAGRADA. 

Cascara Sagrada (B. P.) is the bark of Rhamnus Purshiana, 
U. S., a plant growing in California. It is sometimes called California 
buckthorn, to distinguish it from ordinary buckthorn or Rhamnus 
Frangula, which it closely resembles in many ways, and which may 
be used as a substitute for cascara sagrada in some cases. 

Therapeutics. — Cascara sagrada ought never to be used as a purge, 
but only as a laxative. It is by far the best remedy we have when 
employed simply to empty the bowel of fecal matter in cases of con- 

1 While the rule that an acid is incompatible with a tincture is not recognized in this mixture, 
the quantities of acid and alcohol are so disproportionate that ether in any amount is not devel- 
oped. 



CASTOR OIL. 157 

stipation, since it not only performs this function without intestinal 
disturbance, but also simultaneously acts as a tonic to the intestine, 
and so prevents the constipation which usually follows the use of all 
other drugs of its class 

In the United States cascara sagrada is most commonly employed in 
the form of the fluid extract (Fluidextr actum Rhamni Purshiance, 
U. S., or Extraction Cascara? Sagradw Liquidum, B. P.), in the dose 
of from 10 to 20 minims (0.60-1.3) at night or morning and night. 
If 20 minims (1.3) fail to act, 30 minims (2.0) may be used; but if larger 
doses are required, other drugs should be employed as adjuvants, as 
fluidrachm doses of the fluid extract of cascara may produce irritation 
of the bowel, and enteritis or intestinal catarrh. The objection to 
cascara sagrada is its bitter taste, which may be partially disguised by 
the additional use of Syrupus Aurantii, in the proportion of 1 part 
of the cascara extract to 2 parts of the syrup of orange-peel. The 
B. P. has a preparation, Syrupus Cascara? Aromaticus, which is given 
in the dose of 1 to 4 drachms (4.0-16.0). 

Some of the preparations of this drug are now made in an almost 
tasteless form, such as "Cascara Cordial," an aromatic preparation 
useful for children who are constipated, or the non-bitter fluid ex- 
tract made by a prominent firm in the United States and called 
"Cascara Evacuant," and used in the dose of 20 minims (1.3). The 
solid extract (Extractum Rhamni Purshiana?, U. S. ; Extractum Cascara? 
Sagrada, B. P.) is given in the dose of 2 to 8 grains (0.12-0.5) in pill. 

CASSIA FISTULA. 

Cassia Fistula, U. S., is the fruit of Cassia Fistula, or Purging 
Cassia, as it is sometimes called, and occurs in long, dark-brown pods 
containing a dark pulp in each segment. This pulp is the useful part 
of the drug, and is official in the B. P. as Cassia? Pulpa. Cassia fistula 
ought never to be used alone, as it is too apt to cause pain and griping, 
but it is officially present in the Confection of Senna (Con)ectio Senna>, 
U. S. and B. P.), and may be given in the dose of J to 1 drachm 
(2.0-4.0) as a laxative, or as much as \ ounce (16.0) may be used if a 
purgative effect is desired. 

CASTOR OIL. 

Castor Oil (Oleum Ricini, U. S. and B. P.) is a fixed oil derived 
by expression from the beans of Ricinus Communis, a plant of the 
United States and elsewhere, but originally derived from India. It 
contains an acrid substance, ricinoleic acid. 

Physiological Action. — The manner in which castor oil purges is 
somewhat in doubt, but its activity probably depends upon the pres- 
ence of the acid just named and the fact that it is an oil. 

As is well known, oils — such as olive oil, for example — if given in 



158 DRUGS. 

considerable quantity, tend to move the bowels, and the ricinoleic acid, 
which is somewhat acrid, stimulates the small and large gut, and so 
develops peristaltic movement. According to some writers, this acid is 
not set free until the oil is attacked by the pancreatic juice. That this 
acid possesses purgative properties of itself seems proved by the fact 
that the oil will purge when it is rubbed on the skin, and that nurs- 
ing mothers on taking the oil eliminate the acid in the milk to such an 
extent that the suckling is purged. According to the studies of Ruth- 
erford and Vignal, the oil has no effect over biliary secretion other 
than that violent purgation indirectly increases the flow, and the 
researches of Hess have shown that the oil acts more rapidly in the 
small than in the large gut, and only produces peristalsis by coming 
in contact with the mucous membrane. 

Therapeutics. — Castor oil is the blandest and most unirritating 
purge we have, with the exception of the sulphate of magnesium, 
which is depletant and much more rapid in its effects. While Epsom 
salt will act in one-half to one hour if the stomach is empty, castor oil 
will generally act in four hours, or perhaps five. 

Castor oil is used whenever irritant materials, such as bad food, 
putrid flesh, or decaying or green vegetables, have been eaten, even 
if the inflammation set up after them is very active. If hard bodies, 
such as broken cherry-stones, have been swallowed, castor oil is a far 
better purge than sulphate of magnesium, as it is more gentle and 
lubricates the gut, thereby preventing scraping and irritation. Where 
mucus has accumulated in the bowel in children, and must be gotten 
rid of before other treatment is resorted to, castor oil should be used. 
Previous to parturition it has been largely used to relieve the bowels 
of fecal matter, and is said by some practitioners to make the labor 
easier than if any other purge is used. This is doubtful. It is also 
employed in the constipation following acute diseases and in that 
occurring in infants and children. 

The disadvantages of castor oil lie in its taste, the fact that it is 
oily, that it tends to produce hemorrhoids if used constantly, and 
finally that its frequent use, or even a single dose, is generally fol- 
lowed by more obstinate constipation than existed before, so that the 
dose must be rapidly increased in size to be effective. This is one of 
the reasons why it is useful in irritative diarrhoeas, for, having swept out 
the mucus and offending matter, it checks the movements of the bowels 
afterward. The purgative effect of castor oil is very much increased 
if a little bicarbonate of sodium is given with it. 

Recent reports show that some cases of severe neuralgic headache 
may be cured by the use of small daily doses of castor oil. How it 
acts is not known, unless it unloads the bowels and so prevents toxaemia, 
which, in turn, has caused nervous irritation. 

Administration. — Castor oil is very much more agreeable to the 
taste if pure than if poorly prepared. It is also true that too great 
purification renders it less active. 



CAUSTIC POTASH. I59 

The methods directed for taking castor oil are as various as the 
tastes of individuals. Its odor may be masked by a drop or two of 
the oil of bitter almonds, but emulsions of the oil are not of any ser- 
vice, save to interfere with its efficiency. Some take the oil in the 
foam of beer or porter, others in syrup of sarsaparilla and soda-water, 
and still others in milk or cream. A good way to take it is to eat one 
or two strong so-called cream peppermint drops, or even the crys J al- 
line peppermint drops, swallow the oil from a spoon which is to be 
placed well back in the mouth, and immediately eat several other 
peppermints. This plan is improved by using the oil in milk or water, 
so that the liquid carries the oil down into the oesophagus without its 
touching the mucous membranes. It may also be taken in highly 
seasoned beef-tea. Ringer recommends the following: \ ounce (16.0) 
of oil, fresh syrup of acacia 3 drachms (12.0), and distilled water 5 
drachms (20.0), flavored with a little oil of lemon or peppermint. 
Wood advises that it be mixed with glycerin, equal parts, to which is 
added a drop or two of oil of gaultheria or oil of cinnamon. By far 
the best way of administering it is in soft capsules containing from \ 
to 1 drachm (1.0-4.0). Most persons can swallow as much as a tea- 
spoonful in capsule, and several capsules containing this quantity, 
or a smaller amount, may be given at once to complete the necessary 
dose. The capsules should be dipped in water in order to render 
them slippery and so more easily swallowed. 

The dose of castor oil for an infant is 1 to 2 fluidrachms (4.0-8.0), 
and for an adult \ to 1 fluidounce (16.0-30.0). Often, however, small 
doses will act when it is desired to sweep out of the bowel foreign 
matter that is causing diarrhoea. 

Owing to the fact that the oil will very frequently produce griping, 
a few drops of laudanum should be added to it, or tincture of bella- 
donna may be used. If these cannot be employed, a drop of the oil 
of cinnamon is equally useful for this purpose. 

Under the name of Mistura Olei Ricini the B. P. recognizes a mix- 
ture of castor oil made into an emulsion and given in the dose of 1 to 2 
fluidounces (30.0-60.0). 

CATECHU. 

(See Gambir.) 

CAUSTIC POTASH. 

Caustic Potash (Potassii Hydroxidum; Potassa Caustica, B. P.) is a 
hard white solid, which readily deliquesces; it possesses great caustic 
pow r er, and is used in medicine for the purpose of burning away growths 
or exuberant ulcers. In small cutaneous cancers it is applied to the spot 
for a minute or two after the protecting scab is removed. The parts 
are then poulticed for several days, when the slough comes away. A 
piece of the drug, placed on the skin by means of a pair of forceps, will 
at once soften and burn the tissues for some distance. The surrounding 



160 DRUGS. 

skin should be protected by wax, suet, or oils, and a piece of adhesive 
plaster with a hole for the growth should first be applied to prevent 
action on the surrounding healthy tissues. The burn produced by 
caustic potash is very painful, and cauterization through its influence 
should not be practised if it can be avoided. When the caustic has 
acted sufficiently, it is to be washed off with vinegar or other dilute 
acid to neutralize it. Vienna paste (Potassa cum Calce) is used for the 
same purpose as is caustic potash. 



CAUSTIC SODA. 

Caustic Soda (Sodii Hydroxidum, U. S.; Soda Caustica, B. P.) is 
milder than caustic potash, and its action is more readily controlled. 
It should be used in the same way and for the same purposes as is 
caustic potash, and the surrounding skin ought to be protected by 
adhesive plaster and oil or ointment. 

The soda must be kept in well-stoppered bottles made of hard, 
strong glass. The only official preparation of caustic soda in the 
U. S. P. is Liquor Sodii Hydroxidi, or solution sodium hydroxide. 



CERIUM OXALATE. 

Cerium Oxalate (Cerii Oxalas, U. S. and B. P.) is a white granular 
powder, permanent when exposed to the air, odorless and tasteless, 
and insoluble in water and alcohol, but freely so in hydrochloric acid. 

Therapeutics. — Cerium oxalate is often used instead of or combined 
with bismuth in the treatment of the vomiting of pregnancy or that 
due to uterine disorders and displacements, and in some cases of gastric 
acidity. The dose is from 2 to 5 grains (0.12-0.3), given in pill-form 
every four or five hours. 

CHENOPODIUM. 

Chenopodium is the fruit of Chenopodium ambrosioides, or Ameri- 
can wormseed. The seeds contain a volatile oil and have a distinct 
and rather disagreeable aromatic odor. These seeds, rubbed up 
into a powder, form with a syrup an electuary which is a most 
efficient remedy for Ascaris lumbricoides, or round-worm, as it 
occurs in children. The dose of the powdered seeds is from 10 
to 30 grains (0.60-2.0). The better way of using chenopodium is 
in the form of the oil {Oleum Chenopodii) in the dose of 10 minims 
(0.6) to a child of five years, either on sugar or in an emulsion made 
of gum acacia. If the patient is old enough, capsules may be used. 
The general dietetic measures adopted for the removal of worms should 
be insisted upon before the drug is given. (See article on Worms.) 



CHLORAL {HYDRATED CHLORAL). 161 

GHIMAPHILA. 

Chimaphila (U. S.), or Pipsissewa, is the leaves of Chimaphila 
umbellata, an evergreen found in America, Europe, and Asia. 

Therapeutics. — Pipsissewa is a drug employed in atonic renal con- 
ditions, particularly of the functional type, as a stimulating diuretic, 
which will bring into activity the secreting structure of the kidney 
and the mucous membrane of the genito-urinary tract. It is also a 
tonic to the stomach. For this reason it is often placed in mixtures 
given to dropsical patients if debility and anorexia are present. In 
the treatment of ulcers of the skin due to struma it is said to be of ser- 
vice, and it probably has some slight alterative power. The drug may 
be used in the form of a decoction, which is not official, in the dose of 
1 to 3 fluidounces (30.0-90.0), and as the fluid extract {Fluidextr actum 
Chimaphila?, U. S.) in the dose of \ to 1 drachm (2.0-4.0). 

CHIRETA. 

Chireta (Chirata, U. S. and B. P.) is the plant Swertia Chirata, 
which is a native of India. It is a bitter tonic, possessing a very dis- 
tinct influence over the liver, and, unlike many bitter tonics, is devoid 
of tannic acid. For this reason it may be used with preparations of 
iron. Chireta may be given in cases of indigestion and loss of appetite, 
particularly where the liver is torpid or if any tendency to constipation 
is present, although it is not directly laxative. When given in powder 
the dose is 20 grains (1.3) ; the dose of the fluid extract {Fluid- 
extr actum Chirata?, U. S.) is 30 minims to 1 drachm (2.0-4.0), while 
that of the tincture (Tinctura? Chirata?, B. P.) is 1 to 4 drachms 
(4.0-16.0). The unofficial solid extract may be given in pill in the dose 
of 2 to 4 grains (0.12-0.25). The dose of the infusion (Infusum 
Chirata?, B. P.) is a wineglassful (30.0). Liquor Chirata? Concentratus, 
B. P., is given in the dose of 1 drachm (4.0). 

CHLORAL (HYDRATED CHLORAL). 

Although the name Chloral is applied to the substance used in 
medicine, chloral itself is never so employed, hydrated chloral (Chlor- 
alum Hydralum, U. S.; Chloral Hydras, B. P.) being the real prep- 
aration. Hydrated chloral is a white, crystalline body, but is often 
sold in irregular broken masses, which are generally impure. It 
should be kept in tight bottles in a cool, dark place. 

Physiological Action. — When chloral is applied to a mucous mem- 
brane, it causes distinct reddening and burning pain, and finally acute 
inflammation. It is, therefore, a local irritant. Chloral acts in the 
body as chloral, and is not broken up into formic acid and chloroform, 
as was taught at one time. 

Nervous System. — In medicinal and toxic dose chloral produces 
sleep by quieting the intellectual centres in the brain, at the same 

11 



162 



DRUGS. 



time depressing the motor tract of the spinal cord and the motor 
nerves. In medicinal amounts it does not decrease sensation, but in 
toxic doses it does. Very often hyperesthesia of the skin results from 
small doses. Reflex action is decreased by its sedative influence on the 
motor portions of the spinal cord. 

Circulation. — A dose of 10 to 20 grains (0.60-1.30) in the healthy 
adult rarely causes any circulatory change, but larger amounts pro- 
duce a fall of arterial pressure and a slow, feeble, or sometimes a rapid- 
running pulse, due to a direct depression of the heart-muscle, for 
chloral in overdose is a cardiac paralyzant 



Fig. 18. 



Fig. 19. 





Fig. 21. 



D 



F 



Fig. 20. 





Fig. 18. — A, chloral causes sleep by quieting intellectual centres in brain. 

Fig. 19. — B, depresses motor centrifugal tracts of cord; C, depresses motor nerves; D, does 
not depress the muscles. 

Fig. 20. — E, depresses heart-muscle. 

Fig. 21. — F, depresses the respiratory centre in the medulla. 

After death from chloral the blood may be found dark and grumous- 
looking, with the corpuscles broken down, but these changes occur 
only after very large doses. 

Respiration. — In moderate amounts no respiratory effect is felt, 
but in toxic doses the breathing becomes slower and slower and more 
and more shallow, until it stops in death. When death is caused by 
chloral it is primarily due to respiratory failure, but there is an almost 
simultaneous arrest of the heart. 



CHLORAL. 



63 



Temperature. — Chloral tends to lower bodily heat, and in large 
doses produces a marked fall of temperature, which does much 
toward causing death. Brunton has found that animals will survive 
very large doses of the drug if external heat is supplied to them. The 
fall of temperature is, at least in part, due to failure of the circula- 
tion and to vascular dilatation. 

Kidneys, Tissue-waste, and Elimination. — Chloral is elimi- 
nated by the kidneys in the form of uro-chloralic acid and, if given 
in excess, as chloral. Poisonous doses irritate these organs, and may 
produce bloody urine, owing to the nephritis which is set up as the 
drug passes through the renal structures. After chloral is ingested 
the riune of a patient will often react to Fehling's test for sugar. 

Poisoning. — When a poisonous dose of chloral is taken, the individ- 
ual soon falls asleep and then sinks into a deep coma. The respi- 
rations become at first slow and labored, then shallow and feeble. 
The pulse, at first perhaps a little slowed, soon becomes thready and 
shuttle-like, and is finally lost at the wrist. The face is white and livid, 
the forehead and the hands covered with a cold sweat, and the pupils, 
which are at first contracted, soon become widely dilated. Absolute 
muscular relaxation is present, and it is impossible to arouse the patient. 

Fig. 22. 



I 


ii 


in 

a (Id y yiill 


1 fl 1 


\ 1 


" 


ft 


\ 


\ 


1 


11 


| 


\ 


U UU uu U uu IJ 


nil 


^> 


J 


uu 


IU 


w 


u 


u 


y 


Jy 


i 





Shows the effect of digitalis in raising blood-pressure and pulse-force in chloral poisoning (after 
Schmiedeberg): In I the pressure is very low because of the effect of a large dose of chloral; the 
blood-pressure is 40; in II, after the injection of digitalis, it is 60; and in III it is 125, and the 
individual pulse-beat is far stronger than before. 



Very large doses of chloral have been swallowed and retained without 
causing death. Acher has recorded a case in which 330 grains (80.0) 
of chloral and the same amount of bromide of potassium were taken 
at one dose with the recovery of the patient. 



164 DRUGS. 

Treatment of Poisoning. — The physician should apply external 
heat and use emetics in the early stages, or, if the case is seen too late 
for emetics to act because of systemic depression, he should use the 
stomach-pump. This latter means of removing the drug from the 
stomach is safer and more reliable, because the production of vomit- 
ing may result in efforts which will strain the heart. Strychnine should 
be given in full dose, 2V t° to" g ram (0.003-0.006) to stimulate 
respiration, or atropine may be used for the same purpose. The heart 
is to be supported by 10-minim (0.60) doses of tincture of digitalis, 
given hypodermically every twenty minutes until some effect is noted; 
and, as the digitalis is rather slow in its action, it may be preceded by 
ether and ammonia or brandy or whiskey. The patient must not raise 
the head to vomit, and the head should be placed on a lower level than 
the heels to aid in maintaining the circulation of blood in the vital 
centres at the base of the brain. 

In chronic poisoning by chloral or in cases in which the patient has 
come to use the drug as a habit the patient suffers from weakness, men- 
tal and physical, with sudden flushings due to vasomotor disorder, from 
palpitation of the heart, and finally from petechial eruptions, bed-sores, 
ulcerations, and sloughs. 

Therapeutics. — Chloral is one of the purest hypnotics that we have, 
and may therefore be used where simple nervous insomnia is present, 
but not when sleeplessness is due to pain. When pain is present it is 
to be employed in the combination of 10 grains (0.60) of chloral with 
\ grain (0.01) of morphine, as a much more powerful hypnotic effect 
is produced by the combined action of the two drugs than by the use 
of either one of them alone. 

The following prescription may be used: 

K— Chlorali hydrati gijvel iv (8 0-16.0). 

Morphinse sulphatis gr. ij (0.12). 

Syr. lactucarii f^ij (60.0). 

Aquae dest q. s. ad f 3 ii j (90.0). — M. 

S. — Dessertspoonful (8.0), in water, at 10, and at 11 p.m. if necessary. 

In tetanus and strychnine poisoning chloral is one of the best remedies 
we have, as it depresses the motor tract of the spinal cord. In such a 
case it should be given in 20-grain (1.3) doses combined with 60 grains 
(4.0) of bromide of potassium. If the convulsion prevents deglutition 
or is brought on by swallowing, these remedies should be used by the 
rectum dissolved in starch-water; and if the spasm expels them from 
the rectum, the patient should be chloroformed long enough to allow 
the injection to be given and absorbed. The same remedies in small 
doses are to be used in infantile convulsions and in infantile colic 
in the dose by the mouth of J to 1 grain (0.03-0.06) of chloral to 
2 grains (0.12) of bromide of potassium or sodium in a teaspoonful of 
peppermint-water and syrup. In chorea, paralysis agitans, and delir- 
ium tremens chloral is of great service, but must be given cautiously 
in the last-named condition, for fear it may depress the heart, which 
is already diseased by alcoholic excess. Cases are on record in which 



CHLORALFORMAMIDE [CHLORAL AMIDE). Ift5 

chloral has caused sudden death from cardiac failure in alcoholics 
with fatty heart — an accident the liability to which is increased by 
the fact that owing to the addiction of the patient to a narcotic drug 
it requires large doses to produce sleep. In urcemic convulsions 
chloral has been highly extolled, but if any acute renal trouble is 
present, it must not be used lest it irritate the kidneys. In puerperal 
convulsions not dependent upon nephritis 20 to 30 grains (1.3-2.0) 
of the drug may be given, and repeated in one or two hours. 

Hiccoughs, nocturnal epilepsy, and whooping-cough are all indica- 
tions for its use, but in asthma it rarely does good, and if pushed is 
dangerous to the heart. 

Untoward Effects. — Chloral sometimes causes nausea, purging, and 
vomiting by reason of its irritant action. In susceptible persons doses 
of 10 to 15 grains (0.60-1.0) have produced marked redness and 
swelling of the conjunctiva. Sometimes the last-named symptoms are 
only produced when an alcoholic beverage is taken simultaneously. 
In still other cases an erythematous, papular, urticarial, vesicular, or 
petechial eruption may ensue, the latter forms being seen as a rule in 
cases of chronic chloralism. 

Administration. — Chloral is best given in syrup of acacia, simple 
syrup, or water. It should always be well diluted. The syrup of 
chloral (Syrupus Chloral, B. P.) is given in the dose of 1 fluidrachm 
(4.0). The following prescription is useful in insomnia: 

& — Chloralis hydratis . . ... . . 3 j vel ij (4.0-8.0). 

Potassii bromidi 5ij (8.0). 

Syr. pruni virginianse f§j (30,0). 

Aquse q. s. ad foiij (90.0) — M. 

S. — Dessertspoonful (8.0) at night. 

Sometimes chloral can be well given in junket by adding it to a 
liquid rennet, and then adding the rennet to the milk. (See Junket, 
Part III.) 

The question as to the safe dose of chloral is one largely governed 
by the susceptibility of the patient, but alarming symptoms have fol- 
lowed a dose of 30 grains, and death after from 30 to 45 grains. Thirty 
grains in twenty-four hours are certainly ample in most cases. 

CHLORALFORMAMIDE (CHLORALAMIDE). 

Chloralformamide (Chloral] or mamidum, U. S.) is a compound 
formed by the addition of formamide to anhydrate of chloral, and 
is a colorless crystalline substance without odor and of a somewhat 
bitter taste. It is soluble in 9 parts of water and 1J parts of alcohol. 
Chloralformamide keeps well in watery solution without decomposi- 
tion. Its physiological action s closely allied to that of chloral, 
except that it is not quite so depressing to the circulation. Upon the 
nervous system it acts chiefly upon the brain and spinal cord, and 
produces sleep — a result to be expected, since both chloral and form- 
amide are hypnotics It is said not to irritate the stomach and 
kidneys, but it probably is only less irritant than chloral. 



166 DRUGS. 

Therapeutics. — Chloralformamide may be employed in medicine 
whenever chloral may be used. It is decidedly a nervous sedative, and 
in the wakefulness of nervous Insomnia is very useful. Sleep generally 
ensues about thirty or forty-five minutes after it is taken. According 
to most of the reports published so far, the drug relieves pain as well 
as produces sleep, and is therefore distinct in its actions from chloral. 
In neuralgia it is very useful, and it has been found of value in the 
pains of tabes dorsalis. The dose is 10 to 30 grains (0.60-2.0), which 
may be repeated in three or four hours, although the sleep generally 
lasts five to eight hours. The following formula may be used for its 
administration : 

R. — Chloralformamidi . . gr. xl (2.6). 

Acid, hydrochloric! dil rriv (0.3). 

Syrupi" f 3 i j (8.0). 

Aquae dest fgij (60.0).— M. 

S. — Take in two doses in a little water. 

The late Professor Charteris claimed very extraordinary results in 
the treatment of sea-sickness by the use of equal parts of chloralform- 
amide and bromide of potassium. He gave it in the dose of 30 grains 
(2.0) with an equal amount of the bromide. It is necessary for the 
patient to take a cholagogue for two days before starting on the voyage, 
and as soon as he boards the ship to take the dose named on an 
empty stomach, and at once go to bed and sleep. If this is done, 
Charteris claimed that the patient will awake feeling bright and well, 
and remain so for the rest of the voyage. This combination under the 
name of "chlorobrom" has been also largely used as a hypnotic in the 
treatment of the insomnia due to melancholia and acute mania. 



CKLORALOSE. 

Chloralose is a compound made from anhydrous chloral and glu- 
cose, is soluble in hot water and alcohol, and was introduced into 
medicine as a safe hypnotic and substitute for chloral. Unfortunately 
its taste is acrid, and to some persons nauseous, particularly if taken 
in water. 

Physiological Action. — The physiological action of chloralose is 
practically identical with that of chloral, but much more mild if the 
researches of Mosso are correct. Its dominant effect is on the brain, 
and full doses depress the spinal cord and heart. Poisonous doses 
may produce hemoglobinuria. 

Therapeutics. — The indications for the drug are junctional insom- 
nia, and the beginning dose is 2 to 7 grains (0.12-0.5), but the smaller 
dose should always be tried first, particularly in women. Sleep follows 
its ingestion in about half an hour. 

The best way to administer the drug is to give it in capsule or 
cachet, and to follow it with a glass of water or milk. 

Untoward Effects. — Sometimes chloralose produces diplopia, muscu- 



CHLORATE OF POTASSIUM. 167 

lar tremors, or constant passing of the hands over the head and face. 
If a habit is induced by its constant use, it is a noteworthy fact that 
its power to produce sleep is decreased, while the untoward effects are 
more likely to be marked. In nervous and tuberculous patients it 
sometimes causes tetanic or cataleptic symptoms with disturbed intel- 
lection. 

CHLORATE OF POTASSIUM. 

Chlorate of Potassium (Potassii C Moras, U. S. and B. P.) is a salt 
of potassium differing entirely in its physiological action from all the 
other potassium salts, and, with the exception of the cyanide of potas- 
sium, is certainly the most poisonous. Not only is it, when locally 
applied, an irritant to mucous membranes, but when absorbed into 
the blood it causes changes of a serious character in this fluid, and 
produces acute nephritis if given in overdose. 

In dry form chlorate of potassium ought never to be rubbed with 
organic substances in a mortar, as an explosion may occur. 

Physiological Action. — It has been thought by some that chlorate 
of potassium gives up a large amount of oxygen to the body, and that 
for this reason it would be of value in cases of slow asphyxia, such 
as results from pneumonia or phthisis. It has even been recommended 
to travellers crossing high mountains where the rarity of the air pro- 
duced disagreeable effects; but nothing is more absurd than the belief 
that it gives up oxygen to the body. Chlorate of potassium does give 
off oxygen when exposed to high heat, but not at the temperature of 
the body. Nearly all of it escapes from the body unchanged. 

When overdoses of the chlorate are taken, it produces sickness of 
the stomach, headache, pain in the loins and belly, dyspnoea, cyano- 
sis, heart-failure, and great weakness. Poisonous doses cause the 
blood to be of a chocolate color, this change being due to the produc- 
tion of methamioglobin. The blood-corpuscles are crenated and broken 
down, and after death the liver, kidneys, and spleen are found softened 
and filled with broken-down and disorganized blood. 

Therapeutics. — Chlorate of potassium is useful in stomatitis and in 
mercurial sore mouth as a mouth-wash, or, given internally, in the 
following mixture: 

1^ — Potassii chlorat gr. xlviij (3.2). 

Tr. myrrh foss (2.0). 

Elixir calisayse q. s. ad f §iij (90.0). — M. 

S. — Teaspoonful (4.0) every five hours, or use as a mouth-wash. 

Owing to the fact that the drug is eliminated by the saliva to a great 
extent, the mucous membranes affected by stomatitis are constantly 
bathed by the solution of the chlorate when it is taken by the stomach. 
If any irritation of the stomach or kidneys exist, the medicament must 
be used on a swab and none of it swallowed. 

In diphtheria chlorate of potassium is very commonly employed, 
but its use is exceedingly dangerous. Death in many cases of diph- 
theria is due to the renal irritation present, or, in other words, to an 



168 DRUGS. 

acute nephritis, and this drug simply increases the inflammatory 
process. If the chlorate of potassium is employed in diphtheria, it 
should be used in solution and applied by means of a swab. (See Diph- 
theria.) 

In acute follicular pharyngitis chlorate of potassium is a useful 
gargle, and Wood recommends the use of a solution made by adding 
1 ounce (30.0) of sumach-berries, \ ounce (16.0) of chlorate of potas- 
sium, and 1 pint (480 c.c.) of boiling water to each other, and allowing 
them to simmer for a few hours, when the mixture should be strained, 
cooled, and used as a gargle. 

The following is equally serviceable: 

& — Potassii chloratis gj (4.0). 

Fluidext. rhois glabrae f*ss (16.0). 

Aquae dest q. s. ad fgiij (90.0).— M. 

S. — To be added to an equal quantity of water in a glass and used as a gargle 
every two hours, after stirring. 

This prescription makes an abominable-looking pharmaceutical prepa- 
ration, but an exceedingly useful one. 

In acute rectal catarrh with mucous diarrhea and tenesmus a solution 
of chlorate of potassium in water, 20 grains (1.3) to the ounce (30.0), 
injected into the bowel, will often produce a cure after one or two 
injections. Not more than 4 ounces (120.0) should be used, and it 
ought to be retained for twenty minutes. Often it will be well to add 
the saturated watery solution of the chlorate to an equal quantity of 
starch-water, as the latter aids in allaying the local irritation. This 
same method can be used in the treatment of hemorrhoids, and a few 
drops of laudanum, if added to this solution, will be found of great 
service. The troches (Trochisci Potassii Chloratis. U. S. and B. P.) 
are given in the dose of 1 to 6, each lozenge containing 5 grains (0.3). 
They are intended to be dissolved in the mouth to affect the oral 
mucous membrane, but if many are used they are apt to disorder the 
stomach by reason of the drug being swallowed in the saliva. 

GHLORETONE. 

Under the name chloretone a substance, which is trichlor-tertiary- 
butyl-alcohol, has recently been introduced as a hypnotic and nervous 
sedative closely allied in its uses to chloral, yet differing in the impor- 
tant particulars that it does not depress the heart or respiration unless 
given in excessive quantities, and does not irritate the stomach, but 
acts as a sedative to this organ. For this reason it can be used with 
advantage in vomiting due to irritation and in gastric carcinoma to 
relieve pain. Given in the dose of 10 to 15 grains (0.60-1.0) before 
etherization, it will often prevent after-vomiting, and if vomiting has 
already begun is a valuable agent for its relief. When used to pre- 
vent ether vomiting, it should be given in powder one hour before the 
ether is used. 

The author has also found it of value in relieving the pain of gastric 



CHLORINATED LIME. 169 

ulcer and of gastralgia. As it is both anaesthetic and antiseptic, it can 
be employed as an application to burns, scalds, and lacerations in 10 
per cent, ointment, and local anaesthesia may be produced by the 
subcutaneous injection of it in a 1 per cent, solution of alcohol 15 per 
cent, and water 84 per cent. It may be dissolved in oil of cloves and 
applied on a cotton pledget with advantage in cases of toothache. It 
may also be used to benumb a painful dental nerve by mixing equal 
parts of ether and chloretone and applying this in the cavity. Pow- 
dered chloretone mixed with equal parts of powdered boric acid and 
dusted over painful ulcers, burns, and lacerations or wounds acts as an 
efficient antiseptic dressing, but it may increase the burning at first. 
Chloretone and antipyrin may be given in capsule in the dose of 3 to 
6 grains (0.20-0.4) each and used in restlessness and neuralgia pain. 
The mixture of these substances results in liquefaction, but this does 
not interfere with their therapeutic efficacy. 

Chloretone is efficient in doses of from 10 to 20 grains (0.60-1.3), 
and is best given in sugar-coated tablets of about 3 grains (0.20) each. 

CHLORINATED LIME. 

Chlorinated Lime {Calx Chlorinata, U. S. and B. P.) is the hydrate 
of lime, containing 35 per cent, of chlorine, provided it is of official 
strength. It is an exceedingly irritant substance because of the chlorine 
which it contains, and is never used internally. 

Much of the chlorinated lime sold is useless, containing too little 
or no free chlorine. Good chlorinated lime should be so laden with 
the gas that the face cannot be held near it without the eyes being 
severely irritated. Unless the chlorine is present, the lime is of no 
value, for the employment of chlorinated lime as a disinfectant depends 
upon the action of this gas, the lime being used merely as a vehicle and 
oxidizer, the gas by itself being difficult of application. 

Uses. — As a disinfectant for privies, drains, and sinks chlorinated 
lime is one of the best, if not the best, we possess. A few pounds 
of it may be added every week to the contents of a privy vault with 
great advantage, and a solution of it may be used in bed-pans and 
urinals. When the passages of a patient having typhoid fever are to 
be received in a bed-pan, a chlorinated-lime solution should be placed 
in the receptacle beforehand, so that the fecal matter or urine will 
fall at once into a disinfecting fluid. The solution should be of the 
strength of 1 pound to 2 gallons. As it is one of the most powerful 
deodorizers, chlorinated lime should be placed liberally over and about 
decaying animals, and in exhuming corpses sheets wrung out in a solu- 
tion made as directed above will, if wrapped about the body, be found 
of service to destroy the stench. 

Water which has become fetid by stagnation may be rendered 
drinkable by adding 1 to 2 ounces of the chlorinated lime to every 
65 gallons, and standing the solution aside for some hours until pre- 
cipitation and exposure to the air have gone on for some time. 



170 DRUGS. 

Chlorine fumes will bleach many dyed goods, and therefore colored 
fabrics should not be exposed to them. 

Chlorine gas, in a diluted form, has been used for the treatment of 
aphonia due to cold in cases where the aphonia persists for some 
weeks. It can be liberated by allowing a few drops of hydrochloric 
acid to fall upon chloride of lime or chloride of sodium. 

The placing of chlorinated lime in saucers about sinks and closets 
for the purposes of disinfection is useless, as the amount of chlorine 
liberated is very slight as compared to the volume of air in the room. 
Where the chlorine is present in a sufficiently concentrated form to 
kill germs, it will also kill the occupant of the chamber. A deodorant 
effect may be obtained, but a bad smell, if it exists, even when over- 
come by a greater one, is not really gotten rid of. The official prepa- 
rations of the B. P. are Liquor Calcis Chlorinate and Vapor Chlori. 

CHLORODYNE. 

Chlorodyne is a preparation used largely for the treatment of 
serous diarrhoeas or cramps in the abdomen. Its constitution varies 
considerably, but the formula most commonly employed is as follows : 

fy — Morphinae hydrochlor gr. viij (0.5). 

Aqme dest f5ss (2.0). 

Heat together, and as soon as the morphine is dissolved and the liquid cooled, add 

Acid, hydrochlor. dil f 3ss (2.0). 

Chloroformi f3iss (6.6). 

Tr. cannab. indicae f 3 j (4.0). 

Acid, hydrocyanic, dil Hl x ij (0.8). 

Alcoholis f jss(16.0). 

01. menth. piperit TTJxij (0.8). 

Oleoresinse capsici TTU (0.05). — M. 

g. — 5 to 15 minims (0.30-1.0) for an adult, in water, every two hours for three 
doses. More than this quantity is dangerous. 

A formula closely allied to this is used in tablet form in repeated 
doses. 

CHLOROFORM. 

Chloroform (Chloroformum, U. S. and B. P.) was discovered by 
Guthrie (1831), of Sackett's Harbor, New York, and was first used 
medicinally (1847) by Simpson, of Edinburgh. It is a clear liquid with 
an exceedingly hot, burning, sweetish taste, of a rather agreeable odor, 
and is very volatile. Its chemical name is trichlormethane. Chloro- 
form should be kept in a dark, cool place. 

There are two kinds of chloroform— the purified (Chloroformum, 
U. S.) and the commercial chloroform (Chloroformum Venale). 

If exposed to the light for any length of time, chloroform develops 
carbonyl chloride, hydrochloric acid, and chlorine, which render it. unfit 
for use. If the acid is present, it will turn blue litmus red; and if 
chlorine is present, it will form a white precipitate with nitrate of silver. 



CHLOROFORM. 171 

Such impure chloroform may be rectified by shaking it with slaked 
lime and filtering till the irritating products are gotten rid of. If impure 
because of improper methods of manufacture, an oily odor will be left 
on the hand after evaporation takes place. We find, therefore, that 
chloroform suitable for anaesthesia should be transparent and color- 
less, neutral to test-paper, non-irritating when inhaled, and should 
evaporate completely when placed on a watch-glass, leaving no residue 
or odor. It should have a specific gravity not below 1.476, should 
form no precipitate with AgNO a , should not become brown when heated 
with caustic potash, and only very faintly brown, if at all, when shaken 
with concentrated H 2 S0 4 . The method of manufacture of Pictet, by 
which the chloroform is purified by crystallization, probably gives 
the purest article. In America the chloroform made by Squibb, of 
Brooklyn, is almost universally employed. 

Chloroform vapor in the presence of gas-flame undergoes certain 
changes which result in the development of noxious and irritating 
fumes, consisting principally of hydrochloric acid and chlorine, which 
produce laryngeal and bronchial irritation. The deleterious effects of 
these fumes can, however, be neutralized if a cloth or towel wet with 
aqua ammonia be hung up in the operating-room. 

Physiological Action. — Locally applied to the skin, chloroform may 
produce some tingling and burning even if evaporation be not inter- 
fered with. If confined under a watch-glass on the skin, it will cause 
a blister and act as a counterirritant. 

When inhaled, chloroform produces a sensation of warmth in the 
mouth and throat, a feeling of relaxation, and finally unconscious- 
ness. The respirations are at first full and deep, but soon become 
rapid and shallow. The pulse may be somewhat stronger and fuller 
for a short interval, probably because of mental excitement, but soon 
fails in strength and becomes more rapid. The irritation produced in 
the air-passages by its inhalation is slight, and no primary arrest 
of respiration ensues, as is generally seen after ether is first giVen. 
The pupils are at first slightly dilated, but are contracted during anaes- 
thesia. If the pupils dilate during the use of chloroform after the con- 
traction just named, danger is imminent and death may suddenly occur. 
In some persons the first effects of chloroform are violent struggles, and 
there is danger in trying to overcome these struggles by pushing the 
drug very rapidly. This struggling is particularly apt to be met with 
in athletes and drunkards. Total muscular relaxation should never 
be produced by the drug. 

Nervous System. — Chloroform first affects the brain, then the 
sensory part of the spinal cord, then the motor tract of the cord, then 
the sensory paths of the medulla oblongata, and finally the motor por- 
tion of the medulla, thereby producing death from failure of the vaso- 
motor centre and of the respiratory centre, unless, as rarely occurs, the 
heart has already succumbed to the drug. On the sensory and motor 
nerves, when locally applied, it acts as an irritant and anaesthetic. 



172 



DRUGS. 



Upon these nerve-trunks, when taken by inhalation, it has little or no 
effect. 

Meyer and Overton believe that chloroform acts as an anaesthetic 
by solution of the liquid or fatty constituents of the brain cells. The 
solution is intercellular and the fat is not removed from the cell. The 
concentration of chloroform in the blood serum necessary to cause 
anaesthesia is from 1-6000 to 1-4500. 



Fig. 23. 



Fig. 24. 





Fig. 25. 






Fig. 23. — A, chloroform depresses the vasomotor centre; B, chloroform dilates the heart and 
depresses it; C, chloroform depresses the respiratory centre. 

Fig. 24. — A, chloroform produces anaesthesia by depressing the perceptive centres in the brain, 
and later depresses the (B) intellectual centres, and finally depresses the (C) motor centre. 

Fig. 25. — D, depresses the sensory paths in the spinal cord; E, finally depresses motor tracts 
in the cord. 

Circulation and Respiration. — The effects of chloroform upon 
these vital functions have been for many years a subject of hot dis- 



CHLOROFORM. 173 

pute between surgeons and pharmacologists. On the one hand is 
the school originally led by Syme, of Edinburgh, which has asserted 
that death or danger from chloroform lay in failure of the respiration 
and that this was the function to be watched while chloroform was 
being used; on the other hand, the so-called London school asserted 
that death arises from cardiac failure and that the pulse is the thing to 
be watched during the use of chloroform. The number of clinical and 
laboratory researches which have been carried out to determine which 
of these opinions is correct has been very great, both in England and 
in America, but it has only been within the last twenty years that the 
most competent studies have been undertaken, of which the best known 
is the series made through the munificence of His Highness the Nizam 
of Hyderabad in India, and known as the "Reports of the Hyderabad 
Chloroform Commissions Nos. 1 and 2." The conclusions of the first 
commission having been criticised adversely because it asserted that 
the cause of death was respiratory failure, a second commission was 
formed, and, under a grant of $5000 from the Nizam, Sir Thomas 
Brunton of London was sent out to direct the second investigation. 
Although a teacher of the theory that death from chloroform is due to 
cardiac failure, this gentleman returned to England converted to the 
idea that the cause of most of the fatal accidents under this drug is 
respiratory failure, and the conclusions of Commission No. 2 were 
also criticised by numerous clinicians and pharmacologists in Eng- 
land and America. About this time H. C. Wood and the author 
published a paper in which they expressed their belief in the depress- 
ing effects produced by chloroform upon the heart ; and Mac Williams 
of Glasgow proved by experiment that chloroform causes cardiac 
dilatation and enfeeblement. Shortly afterward the author of this 
book was requested by the government of His Highness the Nizam, 
through Colonel Edward Lawrie, the Residency Surgeon, to carry 
out a series of studies 1 designed if possible to reconcile the contra- 
dictory results reached by the Hyderabad Commissions and other 
investigators, and simultaneously Gaskell and Shore in Cambridge 
University, England, were asked to do likewise. The result has been 
to confirm in every way the results of all previous studies in one respect 
— namely, that the primary action of chloroform on the vital functions 
of circulation and respiration is greatly to depress the vasomotor system, 
thereby causing an extraordinary fall of blood-pressure. Gaskell and 
Shore, to be sure, assert that anaesthesia can be produced by chloro- 
form without causing this fall, but the author has never been able to do 
so (Fig. 18). They also believe that the fall is chiefly a result of cardiac 
failure. From this view the author dissents, because their experiments 
upon which these assertions are based were too complex to give prac- 
tical results; and second, because his own studies and those of others 
show the vasomotor system to be depressed. There is of course some 
cardiac enfeeblement and dilatation, which adds to the fall of pressure. 

1 See Therapeutic Gazette, October, 1893. 



174 



DRUGS. 



As with other discussions in medicine, the truth of the question as 
to whether chloroform causes death by respiratory failure or cardiac 
failure lies, as it were, half-way between the two antagonistic opinions; 
and, further than this, the somewhat startling statement may be made 
that it is not directly due, in the majority of cases, to either of these 
causes. On the contrary, the cause of death from chloroform is usually 
vasomotor depression, whereby the arterioles allow the blood to pass too 
freely into the great bloodvessel areas which exist in the capillaries and 
veins, and as a result the man is suddenly bled into his own vessels as 
effectually as if into a bowl. When it is remembered that the capil- 
lary network of the body will, with the relaxed veins, hold many times 
the normal quantity of blood, and when it is remembered that we can 
inject salt solutions into the vessels to the extent of several times the 



Fig. 26. 




"Vv 



i i i i i i i i n i i i n i t 1 i i n i i i ) m 1 n m i 1 i m m 1 i i i i i i 




l I l 1 M 1 M l I I ) I 1 II I l I I N l I 1 I I M I l 1 I I I I I 1 l I 




Tracings showing the pulse and blood-pressure depressed by chloroform. Note the fall of 
blood-pressure which begins in the upper tracing and becomes marked in the second tracing. 
Also notice the weak pulse shown in the third tracing, illustrating the final depressant effect of 
the drug on the heart. The respiration ceased at X, but the heart continued to beat. The 
blood-pressure failed first, then the pulse, then the respiration, and last of all the heart stopped. 
(Reduced from natural size.) 



normal quantity of blood without raising the blood-pressure, it at once 
becomes evident that the complete vascular relaxation caused by chloro- 
form results in failure of all the vital functions, not because the drug 
has paralyzed the heart or respiratory centre, but because these parts 
are deprived of blood by its stagnation in the widely dilated capillaries 
and abdominal veins. Studies by Leonard Hill on The Physiology 
and Pathology of the Cerebral Circulation show that this is the case, 
for he asserts that when the blood is no longer flowing to the res- 
piratory centres the heart is still beating, because its coronary 
arteries, being lower down, are more easily supplied by the small 



CHLOROFORM. 175 

blood-stream received by the heart from the veins. These studies are 
proved by the experiments of the author and his assistant, Dr.Thornton, 1 
by every tracing of the Hyderabad Commissions, and all other tracings 
we have ever seen. We may conclude, therefore, that while chloro- 
form without doubt acts as a powerful depressant poison to the respira- 
tory centre and the heart in the same manner as it paralyzes all living 
protoplasm when applied in excess, that when properly given by inhala- 
tion it produces a death equivalent to that resulting from hemorrhage, 
which is a failure of the respiration not so much from a direct depression 
of the respiratory centre as from its deprivation of blood ; and while the 
tendency of the drug is to depress and dilate the heart, just as it dilates 
the vessels of which the heart is merely a highly specialized part, the 
failure in the pulse is due to vasomotor palsy, the patient becoming 
pulseless because the heart has not blood to pump. 

Let us see what evidence supports this view: First, we have the 
laboratory tracings of many independent investigators extending over 
many years and made in all parts of the world, all of which show a fall 
of blood-pressure. Among these may be named Bowditch and Minot, 
of Boston; Coats, H. C. Wood, Gaskell and Shore, the Hyderabad 
Chloroform Commissions; the studies of Wood and the author in 1889 
and 1890, and of the author and Thornton in 1892 and 1893. They are 
confirmed by Hill, who has seen the abdominal vessels engorged with 
blood under chloroform, the medulla almost bloodless, and the heart 
still pumping though respiration had ceased. They are confirmed by 
the author's own experiments, in which he proved that even after the 
respiration had stopped and the carotid was empty, and the dog appar- 
ently dead, it could be resuscitated by visceral compression and artificial 
respiration, and by inversion, whereby the blood left the dilated ab- 
dominal veins for the heart and brain. Again, if a needle was inserted 
through the chest-wall, the heart was found to be beating, for the needle 
moved to and fro; and finally if the chest was opened the heart could 
still be found beating feebly — dilated, it is true, but beating. 

So much for the laboratory evidence. What have we in clinical evi- 
dence ? Equally positive proofs of vasomotor palsy, and none of death 
being purely cardiac or respiratory. For years Chisolm of Balti- 
more, and later Howard Kelly and a large number of others have used 
inversion with compression of the floating ribs in artificial respiration, 
which has forced the blood into the chest and saved life again and 
again. For years the literature of medicine has teemed with reports 
of death from chloroform while the patient was sitting up or half recum- 
bent, because, the blood-paths being dilated, this posture favored 
anaemia of the vital centres. Again, it has been proved that the best 
vasomotor stimulant — belladonna or atropine — given before the chloro- 
form is used increases the safety of the patient, and that compression of 
the limbs by bandages does likewise. Finally, Hill has shown that 
abdominal compression also aids resuscitation by forcing the blood to 

1 Therapeutic Gazette, October, 1893. 



176 DBUGS. 

the heart. On the contrary, saline transfusion, which would seem to 
be indicated, is useless, because the dilated blood-paths will receive all 
the saline for a long time before they will overflow toward the heart, 
for as fast as the fluid flows in they dilate. 

The author therefore believes that while chloroform in its general 
depressing power depresses all vital functions, it is a question of blood- 
pressure which is most important in the healthy individual, although 
the heart may fail if it be damaged by disease before the drug is used. 
Therefore in the use of chloroform we should always keep the head 
low, precede its use by atropine hypodermically, bandage the limbs 
if the case is feeble or already bloodless, and if necessary place com- 
presses on the belly and press them deeply into the abdomen if failure 
of the circulation develops. 

The primary action of the chloroform is to depress the blood-pressure 
chiefly by its vasomotor effect, secondly by its cardiac effect, and 
finally, while the drug does exercise a depressant effect on the respira- 
tory centre, the failure of this centre is chiefly due to anaemia. As, 
however, an intact respiratory centre means regular breathing, we 
watch this function to determine the dose of chloroform actually inhaled, 
and because any variation in this function, as shown in irregular breath- 
ing, means that the chloroform is disordering arterial tension. Death 
from chloroform in a healthy organism, then, is usually a vasomotor 
death, for an intact arterial system is as important to vital function as 
an intact cardiac apparatus. 

Blood. — Upon the blood in the body chloroform has little or no 
effect when it is inhaled. Shaken with chloroform in a bowl the blood 
becomes scarlet in hue. 

Temperature. — Chloroform when taken by inhalation distinctly 
lowers the bodily temperature, probably by aiding in the dissipation 
of heat and by its action on the nervous mechanism of heat-production. 

Elimination takes place by the lungs and by the kidneys, and 
goes on very rapidly, owing to the great volatility of the drug. 

If large amounts are eliminated by the kidneys, these organs are 
apt to become irritated and inflamed. 

Antiseptic Power. — Chloroform, when it is added to organic fluids, 
prevents all changes which depend upon the growth of micro-organ- 
isms. 

Therapeutics. — The first and most important use of chloroform is 
as an ansesthetic, and at this point we come to a question which has 
been for many years a matter of contention between different sections 
of the medical profession — namely, as to whether its use is dangerous. 
In the Southern and Western parts of the United States chloroform is 
nearly always used, but in the Eastern and Northern portions it is 
rarely employed. Southerners certainly seem to take chloroform 
better than Northerners or those living on the Atlantic coast. It is 
impossible to go into a general discussion of this question here; suffice it 
to state that even the most enthusiastic supporters of the use of chloro- 



CHLOROFORM. 177 

form confess that it is a more dangerous drug than ether if carelessly 
used, and, while the advantages of chloroform are many, this one great 
disadvantage overshadows them all. 1 The advantages are — its more 
agreeable odor and the fact that it does not irritate the air-passages, 
owing to the small amount necessary to cause anaesthesia; the fact 
that its use is less apt to be followed by nausea and vomiting; the 
rapidity of its action ; and the small bulk which has to be carried by the 
surgeon. Its disadvantage is — the possibility of its killing the patient. 
We come, then, to the all-important questions: 

1 . Is chloroform a safe anaesthetic ? 

2. Are we to watch the pulse or respiration during t" _e use of the 
drug, and what are the signs in the respiratory function indicative of 
danger to the patient ? 

3. What is the true cause of death from chloroform? 

4. Is death from chloroform possible when it is properly admin- 
istered ? 

5. Under what circumstances is the surgeon to use chloroform in 
preference to the less dangerous anaesthetic, ether ? 

6. What is the best way of administering chloroform? 

To the first question the answer is, Yes for the majority of cases, 
provided it is given by one who is skilled in its use, and not only knows 
how to give it, but also how to detect signs of danger. It is not so 
safe as ether at any time, other things being equal, and never safe in the 
hands of a tyro. 

To the second question the answer is, Watch the respiration, because 
as soon as enough chloroform is used to endanger the circulation the 
respiration will show signs of abnormality, either in depth, or shal- 
lowness, or irregularity. In other words, the very effect of the drug 
may be to cause such deep and rapid respirations that an excessive 
quantity of the drug is taken into the lungs and continues to be 
absorbed even after the inhaler is withdrawn. 

As there is always a fall of blood-pressure under chloroform, it is 
difficult to feel the radial or temporal pulse, and the respiratory centre 
recognizes the degree of arterial depression which its sister vasomotor 
centre has permitted by finding that its blood-supply is insufficient. As 
respiration fails first, it should be watched first. It is only by watching 
the respiration that we can tell how much chloroform the patient is 
getting. We do not watch this function for danger alone, but to 
determine the dose. 

Every one is agreed that the patient taking chloroform should have 
plenty of fresh air, and in India, to all intents and purposes, patients 
are operated on in the open air, at least as compared to the closed 
rooms necessary in America and Europe. This free supply of air is 



1 The mortality based upon many tens of thousands of cases in which chloroform has been used 
is about 1 in 2039 (Gurlt); or according to the combined statistics of Julliard and Ormsby, in 
676,767 administrations there were 214 deaths — 1 in 3162, 

12 



178 DRUGS. 

important, whether death is believed to be imminent from cardiac or 
respiratory failure; but this supply of air matters little to the patient if 
he does not breathe freely, nor does the quantity of chloroform amount 
to aught if it is not drawn into the lungs. The dose of chloroform is 
not the amount on the inhaler, but the amount taken into the lungs, 
and, finally, the amount absorbed by the bloodvessels. The rapidity 
and depth of respiratory movements is, therefore, as Lawrie asserts, 
the key to the situation. We withdraw chloroform, as Lawrie says, 
whenever respiration becomes disturbed in rhythm or when struggling 
disturbs it, because it is the first indication that the drug's action is 
uncertain, and because there is no means of determining the dose which 
is absorbed. While watching the respiration will not warn us of a sudden 
cardiac arrest in fatty heart plus chloroform depression, neither will the 
pulse give us such warning; and we are confident that the statement 
of the Hyderabad Commission, that the respiration should be watched, 
is correct, for we believe, from a series of observations that gradual 
cardiac failure never occurs without producing respiratory changes 
from the very first. In other words, we do not believe that in a 
healthy heart chloroform can cause serious disorder without, as a 
result of beginning disorder, disturbing respiration; and, second, 
that in the healthy heart a quantity of chloroform sufficient to disorder 
it will by its direct action disorder the respiration. If, as an extra 
precaution, one assistant watches the pulse while another watches 
the respiration, very well, for though the respiration is the more 
important function to watch, the man watching the pulse might dis- 
cover an irregularity which the ansesthetizer may not see reproduced 
in the respiratory action; but as. divided attention generally means a 
slighting of both objects in view, Lawrie is right in insisting on the 
pulse being ignored. 

The answer to Question 3 is that death is always due in the healthy 
person to vasomotor failure accompanied by respiratory depression, 
the vascular relaxation being severe enough to cause death even if 
artificial respiration is used skilfully. 

The answer to Question 4 is, Yes. The physician having a case of 
heart disease requiring surgical interference should always advise the 
patient of the danger of any anaesthetic, and he should remember, 
whether it be wise to tell the patient or not, that anaesthesia always 
means an approach to death even in the healthiest of men. In the 
event of a death under chloroform the physician is blameless if he 
has taken suitable preliminary precautions and given the chloroform 
properly. 

To Question 5 we have several answers to make : 

1. Chloroform maybe used in hot climates (when ether is inap- 
plicable), where a free circulation of air increases the safety of the 
patient. 

2. Chloroform may be used whenever a large number of persons are 
to be rapidly anaesthetized, so that the surgeon may pass on to others 



CHLOROFORM. 179 

and save a majority of lives, even if the drug endanger a few, as on 
the battlefield, where only a small bulk of anaesthetics can be carried. 

3. The employment of chloroform is indicated in cases of Bright's 
disease requiring the surgeon's attention owing to the fact that anaes- 
thesia may be obtained with such a small quantity of the drug that 
the kidneys are not irritated, whereas ether, because of the large 
quantities necessarily used, would irritate these organs. Quantity for 
quantity, ether is, however, the less irritant of the two. 

4. In cases of aneurism or atheroma of the bloodvessels, where 
the shock of an operation without anaesthesia would be a greater 
danger than the use of an anaesthetic, chloroform is to be employed, 
since the struggles caused by ether and the stimulating effect which 
it has on the circulation and blood-pressure might cause vascular 
rupture. 

5. In children or adults who already have bronchitis, or who are 
known to bear ether badly, or, in other words, have an idiosyncrasy 
to that drug, chloroform may be employed. 

Other indications for the use of chloroform in preference to ether are 
in the performance of brain surgery, where ether is apt to produce 
meningeal congestion by vomiting. In performing tracheotomy, if 
the case is urgent and the ether produces respiratory irritation, chloro- 
form may be used with advantage . 

Chloroform inhalations have been recommended in excessive chorea 
and in puerperal convulsions, and are of great service in the reduction 
of hernia, owing to the muscular relaxation produced. 

Sometimes a few whiffs will put a nervous patient to sleep, but its 
use as a hypnotic is very dangerous, as it may produce a habit, and 
the habit is apt to end fatally. 

Parturient women seem able to take chloroform with more safety than 
other women. There are four important factors in lessening the 
danger of chloroform in this class of cases: 1st. Less chloroform is 
given than is usual in surgical operations. 2d. The pregnancy may 
produce immunity by reason of the slight cardiac hypertrophy pro- 
duced at this time. 3d. The absence of fright, for the woman welcomes 
the anaesthetic. 4th. The frequently recurring pains of labor so 
stimulate the vasomotor centre that the dominant action of chloroform 
— namely, vasomotor depression — is combated. 

In severe whooping-cough a few drops of chloroform may be poured 
on the hand of the attendant and the hand held before the child's face. 
While the child may at first dislike the odor of the drug, the relief given 
soon teaches the patient its value, and he will ask for it when he feels 
the attack coming on. If the attack is prolonged and violent, this 
treatment must be used with caution, owing to the strained condition of 
the heart-muscle, which may be still further depressed by the frequent 
use of the drug. The drug should not be poured on a cloth, but on the 
nurse's hand. In this way too much of it cannot be given to the patient 
at one time. 



180 



DBUGS. 



Administration. — When chloroform is given it should be poured 
drop by drop upon a folded napkin or towel, and the cloth should 
then be held about three to six inches from the mouth and nose, so 
that the vapor may be thoroughly mixed with air in the proportion of 
2 per cent, of vapor to 98 of air; 0.5 per cent, does not cause uncon- 
sciousness and 5 per cent, is dangerous. The administration must be 
gradual, as " pushing " the anaesthetic is dangerous. 

The safest method of administration is by Lawrie's or Esmarch's 
inhaler, because these provide a free circulation of air and the atten- 
tion of the anaesthetizer is not distracted from the respiratory move- 
ment by the manipulation of complicated apparatus. 

The dangers of chloroform seem to be considerably decreased by 
the simultaneous administration of oxygen gas with the anaesthetic 
vapor. (For the best method of using oxygen and chloroform together 
see Oxygen, Important.) 

Fig. 27. 




Esmarch's inhaler and chloroform bottle. The inhaler consists of a wire frame covered by a 

piece of thin flannel. 



The author largely agrees with Lawrie's published conclusions, 
which are as follows with slight modifications: 

1. The chloroform should be given on absorbent cotton, stitched 
in an open cone or cap. 

2. To insure regular breathing, the patient, lying down, with every- 
thing loose about the neck, heart, and abdomen, should be made to 
blow into the cone, held at a little distance from the face. The right 
distance throughout the inhalation is the nearest which does not cause 
struggling or choking or holding of the breath. 

3. The administrator's sole object while producing anaesthesia is 
to keep the breathing regular. As long as the breathing is regular 
and the patient is not compelled to gasp in chloroform at an abnormal 
rate, there is comparatively little danger. 



CHLOROFORM. 



181 



4. Irregularity of the breathing is generally caused by insufficient 
air, which causes the patient to struggle or choke or hold his breath. 
There is little or no tendency to either of these untoward effects if 
sufficient air is given with the chloroform. If they do occur, the cap 
must be removed and the patient allowed to take a breath of fresh 
air before the administration is proceeded with. 

5. Full anaesthesia is estimated by insensitiveness of the cornea. 
It is also indicated by stertorous breathing or by relaxation of the 
muscles. Directly the cornea becomes insensitive or the breathing 
becomes stertorous inhalation should be stopped. The breathing 
may become stertorous while the cornea is still sensitive. The rule to 



Fig. 28. 




Lawrie's collapsible inhaler, made of four small pieces of bamboo covered with muslin. The 
chloroform may be dropped on the sides of the inhaler. 



stop the inhalation should, notwithstanding, be rigidly enforced, and 
it will be found that the cornea always becomes insensitive within a few 
seconds afterward. 

Above all, it is necessary to remember the fact that a person hav- 
ing taken chloroform twenty times before does not show he is not 
in danger on taking it the twenty-first time ; and it is also to be borne 
in mind that many of the sudden deaths from chloroform have occurred 
during the first stage of the inhalation of the drug, before conscious- 
ness has been lost, and, therefore, when an accident was least expected. 

In operations about the mouth chloroform may be employed by 
passing a soft catheter through the nose and then by means of a hand- 
bulb attached to a small wash-bottle containing chloroform or by 



182 



DRUGS. 



Fig. 29. 




Krohne and Seseman's modification of 
Lawrie's inhaler, with feather respiration- 
indicator attached. The inner lining is of 
white felt, the outer case is of leather. The 
chloroform may be poured on the felt a hot, burning taste aboilt 
through a small hole in' the leather on the 
top of the inhaler. 



means of a Junker inhaler introducing into the post-nasal spaces 
chloroform vapor mixed with air. 

It is often a good plan to give atropine or suprarenal gland, pref- 
erably the former, before using chloroform in order to avoid, if pos- 
sible, vascular relaxation. 

Individuals who are robust and strong, and who struggle violently, 
are in greater danger from the use of chloroform than the sickly and 

weak, probably because the struggles 
cause deep inhalation of the drug, 
exhaust the vasomotor system, strain 
the heart, and tend to dilate its walls. 
The question has arisen a number 
of times whether it is possible to 
chloroform a person who is asleep 
without his being wakened. This 
has been decided by numerous tests 
to be possible, particularly if the 
sleep be heavy. 

Chloroform, when taken inter- 
nally by the mouth, causes a sensa- 
tion of warmth in the stomach and 

the lips 
and buccal mucous membrane. In 
overdose it has produced death 
when taken in this manner. Although rarely used in internal medi- 
cine, chloroform in the form of the spirit of chloroform (Spiritus 
Chloroformi, U. S.) or water of chloroform (Aqua Chloroformi, U. S.) 
is useful in cough mixtures, which are given to persons having an irri- 
tative cough, and in cases where, through nervousness or other cause, 
tickling in the throat or bronchial tubes keeps the patient continually 
in a state of unrest. (See Bronchitis.) 

In gastric or intestinal flatulence 1 or 2 minims (0.05-0.10) of pure 
chloroform, or 10 to 20 minims (0.6-1.3) of the spirit of chloroform, 
will often give relief. The following prescription is useful in all forms 
of abdominal pain and is harmless in ordinary dose: 

fy— Spt. chloroformi f5ss(16.0). 

Spt. camphorse f5ij (8.0). 

Tr. lavandul. comp q. s. fgiij (90.0). — M. 

S. — Dessertspoonful (8.0) in water every twenty minutes for 4 doses. 

In the treatment of serous diarrhea the spirit of chloroform when 
combined with astringents and opium is most useful, provided that the 
irritating cause is first removed. In renal or hepatic colic a few inha- 
lations, not sufficient to disturb consciousness, will not only give tem- 
porary but sometimes permanent relief by relaxing spasm. Hypo- 
dermic injections of 10 to 15 drops (0.60-1.0) of pure chloroform, 
reaching down to a painful sciatic nerve, have been recommended by 
Bartholow. This is a very painful treatment, and may cause a slough. 



CHLOROFORM. 183 

Rubbed on the chest in the form of chloroform liniment, this drug will 
sometimes prevent asthmatic attacks, but chloroform ought not to be 
inhaled, except most carefully, in this affection, because of the strained 
condition of the right side of the heart. 

In drachm (4.0) doses chloroform has been used as a remedy for 
tape-worm, but ought never to be so employed. 

When placed in liniments of a stimulating character chloroform is 
a very useful application over muscles affected by soreness and stiff- 
ness, as in lumbago and gout, and chloroform liniment may also be 
used over neuralgic areas for its local anaesthetic effect. 

Contraindications. — Chloroform is not to be used in cases of fatty heart 
or dilatation of the heart, in those with a known idiosyncrasy, nor in 
so-called lymphatic persons with overgrowth of lymphoid tissues, as, 
for example, adenoids. In the latter class it is particularly apt to cause 
sudden death. 

In valvular disease of the heart chloroform may be used with cau- 
tion, although ether is preferable. Given a case of valvular disease 
that must be subjected to operation, the chances are bettered with an 
anaesthetic than without it, as the pain and mental shock are worse 
for the heart than is the anaesthetic. 

Fig. 30. 




Showing the attitude in which the head should be held to permit the easy passage of air 
through the glottis. This position raises the epiglottis and lifts the soft palate from the 
tongue. (Martin and Hare's method.) 

Untoward Effects and their Treatment. — Alarming effects produced by 
this drug are far more apt to appear in males than in females, the rela- 
tive proportion being about 6 to 1. Sometimes during the adminis- 
tration of chloroform the heart or respiration suddenly ceases, and in 
some cases this change is preceded by a peculiar shade or cloud which 
passes over the face of the patient ; but death may come suddenly and 
without warning. If untoward effects appear, the anaesthetic must 
be at once withdrawn and artificial respiration resorted to. Injections 
of ether and hot brandy should be given beneath the skin, and the 
poles of a battery with a rapidly interrupted current swept over the body, 



184 



DRUGS. 



but not held over the pnrenic nerve or diaphragm. 1 The patient must 
be held head downward, so that the blood will flow to the brain, as 



Fig. 31. 




Showing the inversion of the patient as adopted by Kelly, and the method of performing 
artificial respiration simultaneously. The chest is expanded by drawing its lower segment 
toward the operator. 

Leonard Hill and the author have shown that the chief cause of 
death is vasomotor relaxation with accumulation of the blood in 
the abdominal vessels. Bandages should be applied to the limbs and 



1 While few text-books give any specific directions concerning the practical application of the 
methods which are to be employed in such emergencies, those that do so force the physician to a 
procedure at once dangerous and impractical; for the directions usually given are, to place the 
positive pole of the battery on the phrenic nerve as it crosses the anterior scalene muscle at the 
root of the neck, the negative pole being pressed against the lower margin of the ribs. A rapidly 
interrupted current is now to be used with the purpose of causing contraction of the diaphragm 
by the direct action of the electricity upon the nerve. Even theoretically this is a possible source 
of danger, and practically the writer has proved danger to be ever present under such treatment. 
The cardiac inhibitory nerves run so closely to the phrenic fibres, and respond so readily to elec- 
trical stimulation, that it is difficult to imagine how they can escape stimulation if a current be used 
of sufficient strength to excite the phrenic nerves near by. By practical experiment the writer 
has proved that inhibition of the heart may not only be possibly brought about by this method, 
but also that it is nearly impossible to avoid such an effect if the phrenics are to be reached at all. 



CHLOROFORM. 



185 



compression by means of a bandage and large compress be exercised 
on the abdominal contents, and active artificial respiration practised 
for a long period of time as the most important measures for the patient's 
relief. External heat should be applied. Atropine, strychnine, and 
digitalis may be used to stimulate the heart and respiration. Of these, 
strychnine is the most valuable. (See directions under the article on 
Ether.) Adrenalin chloride given hypodermically is also of value. 



Fig. 32. 




t'fi 



4 




Same as Fig. 31, except that the floating ribs are compressed to expel the air from the chest. 



In some cases, with the movements of artificial respiration an 
assistant may grip the tip of the tongue with a pair of forceps and draw 
it out of the mouth and upward from ten to fourteen times a minute, 
in order to stimulate the diaphragm. (See Asphyxia, Part IV., for 
detailed directions for resuscitation.) In a certain number of cases 
patients apparently dead from chloroform have been resuscitated by 
repeated compression or massage of the prsecordium. 

The measures adopted for resuscitation should not be stopped for 
at least one hour, as individuals have recovered as long as this after 
an accident from chloroform. 



186 DRUGS. 

Ostertag has found that very prolonged inhalations of chloroform 
in the lower animals produce widespread fatty degeneration. 

Before closing the consideration of the use of chloroform for anaes- 
thetic purposes mention should be made of the so-called anaesthetic 
mixtures. Of these the A. C. E. is the best known. It consists of a 
mixture of 1 part of alcohol (sp. gr. 0.838), 2 parts of chloroform (sp. gr. 
1.497), and 3 parts of ether (sp. gr. 0.735). Billroth's A. C. E. mixture 
is composed of chloroform 3 parts, and ether and alcohol 1 part each. 
The Vienna mixture consists in 1 part of chloroform and 5 of ether, and 
the so-called methylene mixture is 30 percent, methylic alcohol; and 
70 per cent, chloroform. The object of all these mixtures is evident — 
namely, to get the anaesthetic effect of the ether and chloroform without 
the cardiac and respiratory effects of either, and the alcohol when 
added is to act as a stimulant. As the volatility of each ingredient 
varies, the mixture is useless, for the ether evaporates first, and the 
chloroform next, and the alcohol last. The A. C. E. is popular in 
England, but not in the United States. 

The rapidity with which any drug, which produces anaesthesia 
by being inhaled, acts is governed in part by its boiling- or most rapid 
evaporation-point. The higher this point, the greater is its rapidity 
of action and the more prolonged its effects. Thus we find that in the 
case of chloroform, the evaporation-point of which is 65° C, anaes- 
thesia speedily follows its administration in small amounts and lasts 
for some time. Once in the system it is eliminated slowly, because the 
bodily heat is less than its point of most rapid evaporation. On the 
other hand, sulphuric ether boils at 34° C, and for this reason acts 
more slowly and more transiently, because for every breath of ether 
vapor which is inhaled an equal quantity of ether is exhaled, since 
its evaporation-point is less than the normal temperature of the body. 
Schleich has found that if chloroform, sulphuric ether, and petroleum 
ether are mixed, they form a fluid the evaporation-point of which 
varies from 38° C. to 42° C, according to the proportions of the in- 
gredients. By the use of such a fluid for anaesthetic purposes we 
avoid the overeffects of chloroform when used alone and the neces- 
sity of using excessive amounts of ether, and the patient speedily 
returns to consciousness after the inhalation ceases. Further dis- 
agreeable after-effects are said to be not so common or severe as 
with a single drug. These so-called mixtures of Schleich may be 
made in three ways: 

No. 1 is composed of: 

Chloroform 45 parts. 

Petroleum ether . 15 " 

Sulphuric ether 180 " 

The boiling-point of this mixture is 38° C, and as the lower the 
boiling-point the more transient the anaesthesia, it is to be employed in 
operative procedures of about twenty minutes' duration. About 1 ounce, 



CHE OMIC ACID. 187 

or 30 grammes, will be required, given best in an ordinary ether cone, 
made of cardboard and a towel. About three ounces will be needed 
for a period of one hour. If a more prolonged and powerful effect is 
desired, then one of the following mixtures is used, No. 3 being more 
powerful than No. 2, because its boiling-point is higher. 

No. 2: 

Chloroform 45 parts. 

Petroleum ether 15 

Sulphuric ether . 150 " 

The boiling-point of this mixture is 45° C. 
No. 3: 

Chloroform 30 parts. 

Petroleum ether 15 " 

Sulphuric ether 80 " 

The boiling-point of this mixture is 42° C. 

The petroleum ether has no deleterious effects, and seems to modify 
the effect of the chloroform and dilute the sulphuric ether without 
altering its general influence. It is to be remembered that only petro- 
leum ether which boils at 60° to 65° C. is to be used. The ordinary 
petroleum ether, or benzine, of the drug stores, which boils at 55° C, 
is not suitable. 

Aside from the disagreeable odor of the benzine, these mixtures 
are said to cause less cyanosis, less mucous secretion, and other disa- 
greeable effects than any single anaesthetic known, and to be safer in 
every way. 

These mixtures have not proved popular in America, and have 
been abandoned. The author has allowed this description of them 
to stand in the text in this edition as part of the recent history of 
anaesthesia rather than because he thinks it wise to use them. 

Local Use and Internal Administration. — The official preparations of 
chloroform are a liniment (Linimentum Chloroformi, U. S. and B. P.); 
a water (Aqua Chloroformi, U. S. and B. P.), dose J to 2 ounces (16.0- 
60.0); a spirit {Spiritus Chloroformi, U. S. and B. P.), the dose of 
which is 20 minims to 1 fluidrachm (1.3-4.0); and an emulsion 
(Emulsum Chloroformi, U. S.), composed of chloroform, gum traga- 
eanth, oil of almonds, and water, given in the dose of 2 to 4 fluidrachms 
(8.0-16.0). The B. P. recognizes, besides those given, Tmctura 
Chloroformi et Morphince Composita, dose 5 to 10 minims (0.3-0.60). 

CHROMIC ACID. 

Chromic Acid (Chromii Trioxidum, U. S. ; Acidum Chromicum, B. P.) 
is not a true acid, but an anhydride, and occurs in the form of brilliant 
red crystals, which are deliquescent and possess a sour, metallic taste. 
The acid should be kept in glass-stoppered bottles. It should never 
be mixed with sweet spirit of nitre, strong alcohol, or glycerin, or any 
organic matter, as under these circumstances an explosion may result. 



188 DRUGS. 

Therapeutics. — Chromic acid is used solely as a caustic for the 
destruction of growths on the skin or mucous membranes. When a 
limited area is to be destroyed, a small crystal is placed on the part to 
be cauterized ; but if a larger area is to be attacked and severe action 
is required, the liquid resulting from its deliquescence on exposure to 
the air may be employed by means of a glass rod. The surrounding 
tissues should always be protected by lard or adhesive strips. 

J. William White has recorded a death from the application of this 
acid to a large number of condylomata about the buttocks and vulva. 
Where the drug has been swallowed, the patient should be treated for 
gastro-enteritis, and dilute alkalies and lime-water be used, as well as 
emetics and demulcent drinks. 

If a superficial action is desired, a solution containing 100 grains 
to the ounce (6.6-30.0) of water is sufficient, and for small warts and 
similar growths this solution will be found sufficiently strong. 

Liquor Acidi Chromici, B. P., is composed of 1 part of acid to 3 of 
water. 

CHRYSAROBIN. 

Chrysarobin (Chrysarobinum, U. S. and B. P.) is a mixture of the 
proximate principles derived from a powder found in the wood of the 
tree Andira Araroba, which was originally used for medicinal purposes 
in Brazil. In the East Indies it is called " Goa powder." Chrysarobin 
is sometimes misnamed chrysophanic acid, and is a yellow, tasteless 
powder, soluble in solutions of alkalies, in acids, and in ether. 

Therapeutics. — Chrysarobin is given internally in the dose of J 
grain (0.008) in psoriasis and parasitic diseases of the skin, but more 
commonly is employed externally in the form of the official ointment 
(Unguentum Chrysarobini, U. S. and B. P.), which is too strong for 
direct use, and should be mixed with 4 or 5 parts of benzoated lard 
before application to the skin. Even when so diluted, chrysarobin 
may cause great swelling and inflammation of the skin, with desqua- 
mation of the cuticle. Should the surface be broken, the drug may be 
absorbed and cause vomiting. As chrysarobin stains the skin a dark 
brown, it ought not to be used on the face; but should this accident 
occur, the discoloration may be removed by the application of a 
weak solution of chlorinated lime. In psoriasis the following may be 
employed after the patient has taken a bath to soften the scales: 

1^— Chrysarobini . . 3j (4.0). 

^Etheris, 

Alcoholis . aa q. s. ut ft. sol. 

Collodii f§ij (60.0).— M. 

S. — Apply with a brush to the part affected. 



C1M1CIFUGA. 189 



CIMICIFUGA. 



Cimicifuga (U. S.) is derived from Cimicifuga Racemosa, other- 
wise known as black cohosh or black snake-root. It contains a resin 
and a volatile oil, upon which its medicinal powers are supposed to 
depend. The fluid extract and tincture should always be freshly pre- 
pared from the fresh crude drug. It is official in the B. P. as Cimici- 
fuga Rhizoma. 

Physiological Action. — In large doses cimicifuga paralyzes the sensory 
side of the spinal cord of the lower animals, and in consequence 
lowers reflex activity. It has no effect on the nerves and muscles. 
On the circulation the drug acts by depressing the heart and vasomotor 
system. Death is due to respiratory arrest. In small dose it is a feeble 
cardiac stimulant. When full medicinal doses are given to man it 
nearly always produces frontal headache. Its known physiological 
effects have no direct bearing upon its use in medicine. 

Therapeutics. — Cimicifuga is, excepting arsenic, the best remedy we 
have for chorea, particularly if the patient is otherwise in good health, 
but it should be used with careful attention to the regularity of the 
bowels and often be accompanied by iron. It is also indicated where 
there is, in addition to St. Vitus's dance, a rheumatic tendency. In 
chronic bronchitis it is asserted to be of value, and in rheumatism of a 
subacute or chronic type cimicifuga sometimes gives relief. 

Cimicifuga has been highly praised in the treatment of neuralgia 
particularly of the ovarian type, and in amenorrhea, subinvolution 
and tenderness of the womb. To women who state that they cannot 
step off a step without paining or hurting the uterus or ovaries cimi- 
cifuga often gives relief. Some writers assert that it is an efficient 
heart tonic in cases of fatty and irritable heart when digitalis fails. 
There can be no doubt that it is a powerful uterine stimulant, and it 
ought to be used with caution during pregnancy for fear of abortion. 
There are, however, some practitioners who commend its use for the 
prevention of this accident. By reason of this power it may be employed 
instead of ergot during labor, and is said to be better in some cases, 
because it produces normal, not tonic contractions. As a matter of 
fact, it is little used for this purpose. In the treatment of headache 
arising from overstraining of the eyes cimicifuga is said to be 
beneficial. 

The drug is official as the extract (Extr actum Cimicifuga, U. S.), 
dose 1-5 grains (0.06-0.3), the fluid extract {Fluidexir actum Cimici- 
fuga, U. S., or Extractum Cimicifuga Liquidum, B. P.), the dose of 
which is 10 to 30 minims (0.60-2.0) or even 1 drachm (4.0), In 
addition the B. P. contains Tinctura Cimicifuga, the dose of which 
is 1 to 2 drachms (4.0-8.0). 



190 DRUGS. 



CINCHONA. 



Cinchona, U. S., is a name applied to the bark of all the trees belong- 
ing to the genus Cinchona, provided they contain not less than 5 per 
cent, of anhydrous cinchona alkaloids, at least f of which should be 
soluble in ether. There are thirty-one species of this genus, but only a 
comparatively small number can be included in the list of those which 
contain 5 per cent, of alkaloids. These are Cinchona Calisaya, or Cin- 
chona calisaya, which contains the most quinine, Cinchona Ledgeriana, 
Cinchona Officinalis, Cinchona Succiruba, or Cinchona Rubra,\J. S., Cin- 
chona Rubra Cortex, B. P., and Cinchona Pitayensis. (The first is called 
yellow bark, the second pale bark, the fourth red bark.) The alkaloids 
of the quinine series derived from these barks are quinine or quinina, 
quinidine or quinidina, and quinicine, which is an artificial alkaloid. 
Of the cinchonine series we have cinchonine, cinchonidine, and cin- 
chonicine, which last is also an artificial alkaloid. Besides these 
alkaloids there are present kinic and kinovic acids and other inert 
and useless substances. 

As quinine is the most important of the group, and as its physio- 
logical action is virtually identical with that of the rest, whatever is said 
hereafter in this article refers to quinine unless otherwise stated. All 
the alkaloids of cinchona which have been named are not employed 
as pure- alkaloids, but as salts formed by adding sulphuric, hydrochloric, 
or other acid to increase their solubility. 

Physiological Action. — When quinine is taken in overdose, it causes 
ringing in the ears, dizziness, disorders of taste and smell, disturbance 
of vision in some cases, and fulness in the head. Deafness often 
comes on, and is generally, with the roaring in the ears, the most 
annoving symptom. Headache is not uncommon. (See Untoward 
Effects.) 

Nervous System. — Upon the cerebrum quinine acts as a stimu- 
lant, and finally as a congestant if given in excessive dose. If poison- 
ous doses are used, intense cerebral congestion ensues, and finally 
unconsciousness ensues. On the spinal cord of the lower animals 
the drug first causes a decrease in reflex action by stimulating 
Setschenow's reflex inhibitory centre, and finally by depressing the 
spinal cord and nerves. The latter changes occur only after poisonous 
doses. 

Circulation. — If quinine, even in small amount, be injected into 
the jugular vein of a dog, so that it goes in concentrated form to the 
heart, cardiac paralysis will result. If this does not occur, the drug 
simply decreases pulse-force, pulse-rate, and arterial pressure. When 
given to man in small medicinal doses by the mouth, the drug acts as a 
general stimulant to the entire body, and so tends to support the circu- 
lation, increasing to a slight degree the pulse-rate and blood-pressure. 
If the dose by the mouth be very large (15 grains), the pulse is depressed. 
Full doses in fever therefore act as vascular sedatives. 



CINCHONA. 191 

Blood. — After poisonous doses the blood is more coagulable than 
normal, but in medicinal amounts no such effect is produced. The 
effect of quinine on the blood-corpuscles is of great interest. Even 
in full medicinal doses it arrests diapedesis of the white cells from the 
capillaries by a direct action on these cells, and if the drug be applied 
to the mesentery of a frog the cells already extruded cease their move- 
ment, but the intravascular cells do not. On the other hand, if qui- 
nine be given internally in so small a dose that the proportion to the 
blood is as 1 to 20,000, the white cells in the vessels cease to migrate, 
but those cells in the surrounding tissues do not (Binz, Hare, Dissel- 
horst). This is perhaps the explanation of the effects of quinine in 
acute inflammations, for it arrests inflammatory exudation and allows 
the extruded cells to wander from the diseased area. It is stated, 
however, that this is not the case with all animals. Binz asserts that 
in the proportion of 1 : 20,000 quinine diminishes the number of white 
cells. Medicinal amounts gradually increase very materially the num- 
ber of red blood-corpuscles in man. It is said that quinine inhibits 
the oxygen-bearing powers of the red corpuscles, but this probably 
does not occur from medicinal doses. 

Respiration. — Upon respiration quinine acts as a slight stimulant 
in small doses, but as a marked depressant in poisonous amounts, 
death being most commonly due in animals to failure of respiration if 
it be taken by the stomach in lethal dose. 

Temperature. — Quinine lowers bodily temperature in health very 
little if at all, and in fevered states its influence is governed by the 
cause of the fever. Thus in malarial fevers quinine is a powerful 
indirect antipyretic, by reason of its peculiar powers o^er the infection, 
and not because it has any direct influence over heat production and 
dissipation. 

Absorption. — Quinine is absorbed from the stomach, not from the 
intestine, and it is precipitated by the alkaline juices of the bowel. 
For this reason it should be given in cachet, capsule, or powder, 
rather than in compressed tablet, so that it may be absorbed by the 
stomach before it reaches the intestine. If pills are used, only those 
which have been freshly made should be employed. 

Kidneys, Elimination, and Tissue-waste. — Quinine escapes 
from the body chiefly through the kidneys, although some of it is 
destroyed by oxidation in the liver and tissues. The excretion of 
quinine is by no means rapid so far as the entire quantity to be 
eliminated is concerned. While in rare instances it may be found 
in the urine in fifteen minutes from the time it is given, it does not 
disappear from this secretion for about twenty-four hours. In the 
urine it is found as quinine and as dihydroxyl quinine. 

Upon tissue-waste quinine acts as a depressant and decreases the 
elimination of nitrogenous materials. 

Digestive Tract. — Quinine has a bitter taste in as small a pro- 
portion as 1 : 10,000 of water. Upon the stomach it acts as a tonic and 



192 DRUGS. 

stimulant, but if given too frequently, or in large doses, it may irritate 
this viscus. Moderate doses are slightly constipating, and very large 
doses may induce colicky pain. 

Poisoning and Untoward Effects. — Severe poisoning from quinine 
rarely occurs except in persons who have an idiosyncrasy to the 
drug. Roberts has recorded the case of woman, aged thirty-six years, 
who took 5 drachms (20 grammes) and survived, after suffering from 
deep coma, shallow breathing, slow pulse, absolute deafness and 
blindness. The loss of sight lasted two weeks, but the retinal changes 
persisted for several months. Death from an overdose of quinine is 
exceedingly rare. The cases in which death has followed its use are 
medical curiosities. Bouchardat has recorded the case of an adult 
male who died as a result of taking from 45 to 65 grains of the drug. 
Whether this was the real cause of death is doubtful. Soullier quotes 
Tarnier and Budin as asserting that enough quinine may be eliminated 
by the milk to produce death in a nursling. This seems hardly possible. 

"Untoward effects" is the best term with which to qualify the dis- 
agreeable symptoms which sometimes come on in persons having an 
idiosyncrasy to the drug and who are in reality poisoned by small doses. 
In these cases, sudden, complete, but temporary blindness is often met 
with. De Schweinitz has shown that in dogs quinine produces in toxic 
doses constriction of the retinal arteries, thrombosis of the central vein 
of the retina, and permanent optic atrophy; and Holden has proved 
that there is degeneration of the nerve-fibres and ganglion cell-layers 
of the retina. In other instances complete deafness asserts itself, 
due to congestion of the middle ear, while skin eruptions, generally 
of the nature of erythema, are not rarely seen. In other instances 
petechial and vesicular eruptions are developed, and swelling of the 
gums with a tendency for them to bleed may appear (Schulz). After 
lethal doses hemorrhage into the middle ear may be found, and severe 
epistaxis may ensue after so small a dose as 4 grains ^(0. 25) .^ The 
buzzing in the ears can generally be relieved by the administration of 
10 grains (0.60) of bromide of sodium combined with a little ergot. 
Karamitsas has proved that quinine may produce hemoglobinuria in 
persons suffering from malarial poisoning, and apparently may even 
develop bilious remittent fever. 1 Irritability about the neck of the 
bladder may sometimes be produced by quinine. 

Therapeutics. — Quinine is employed in medicine to fulfil three 
great offices, although its influence in other directions is hardly less 
powerful. These are as an antiper iodic or antimalarial, as an anti- 
pyretic, and as a tonic possessing peculiar virtues. 

For many years physicians employed this drug empirically, not 
knowing the cause of the disease called malaria. We now know 
that the theory of Binz, advanced as long ago as 1867, is correct, and 

1 See collective investigation of this subject by the author in Therapeutic Gazette for July, 
1892; also article in New York Medical Record, January 7, 1899. 



CINCHONA. 193 

that malaria is due to the presence of a germ, the plasmodium malarise, 
which was first accurately studied by Laveran and named by Marchia- 
fava and Celli. These and other investigators have found that quinine 
acts as an active poison to these germs, even in so weak a solution as 
1 : 20,000. 

For the reasons given in the preceding paragraph quinine is the best 
remedy for malarial fever as a prophylactic and cure, and it should 
be given in doses which are indicated by the state of the patient. 
(See Malarial Fever.) If possible it should always be preceded by a 
purge having an hepatic action. This preliminary treatment is particu- 
larly important in bilious or remittent fever. The drug should be given 
in hourly doses, or in one or two large doses in such a way that its influ- 
ence is fully exercised, not only at the time of the expected paroxysm, 
but about an hour or thirty minutes before that time. If the paroxysm 
is near at hand, the drug should be given in solution, bitter though it be, 
in acidulated water. If the attack be so far advanced as the sweating 
stage, it should be given nevertheless to destroy the spores just set free. 
(See Intermittent Fever.) 

As a prophylactic against malaria the dose of quinine should be 2 
to 4 grains (0.12-0.25) or more three times a day. 

In hemorrhagic malarial fever quinine sometimes seems to do more 
harm than good. Under such circumstances the danger in using 
quinine consists in irritating the engorged kidneys after the chill has 
passed. Quinine is not a haemostatic, and only does good in malarial 
hematuria by preventing the paroxysm which produces the bloody 
urine. In hematuria occurring in persons broken down in health 
as a result of chronic malarial infection quinine is of no value unless 
an examination of the blood reveals the presence of parasites due 
to a new infection. To give quinine after this symptom appears is 
to "lock the door after the horse is stolen" unless the parasites are 
found in the blood. Indeed, it would seem from the studies of many 
physicians in America, Greece, and Italy, that the use of quinine is 
capable of developing a hematuria. 1 (See Hematuria.) If, however, 
an examination of the blood reveals the malarial parasite, the drug 
should be freely used. 

In pernicious malarial fever quinine should be given by the mouth, 
by the rectum, and hypodermically, and even intravenously, as much 
as 60 to 70 grains (4.0-4.6) being used. 

In brow ague or malarial neuralgia quinine often acts most usefully, 
and this is also true in some cases of nerve-pain not dependent upon a 
specific disease. 

For the reduction of the pyrexia of typhus' or typhoid fever quinine 
is inferior to the new antipyretics, even when given in very large 
dose, and it ought to be used rarely, if at all, for this purpose. In 

1 See collective investigation of this subject by the author in Therapeutic Gazette for July, 
1892; also article in New York Medical Record, January 7, 1899. 

13 



194 DRUGS. 

all fevers it will seldom cause a fall of temperature before crisis or 
lysis, but will aid in the fall very actively after these changes have 
occurred. In those cases of fever in which the use of quinine is fol- 
lowed by marked improvement the good results are due either to its 
specific antimalarial influence or to its stimulating influence on the 
general system. 

As a tonic quinine acts not only as a simple bitter, but also seems to 
have a direct effect in increasing the number of the red blood-corpuscles. 
The tonic dose should be 1 to 2 grains (0.06-0.12) three times a day. 

Quinine has been used to overcome uterine inertia in weak women, 
but it is a feeble remedy, and is seldom resorted to by progressive 
obstetricians. (See Kola.) It will not of itself cause abortion, but in 
nervous, hysterical women who have a tendency to abort, and to whom 
it is necessary to give full doses of quinine during pregnancy, it may 
be well to combine some sedative, as one of the bromides or opium, 
with the antiperiodic. 

In the lobar pneumonia of children quinine should be used in sup- 
positories in the dose of 2 grains (0.12) three times a day. 

Acting on the belief that chorea is due to lack of inhibitory control 
of muscular movements, Wood has urged the use of quinine in large 
doses in this disease as a stimulant to inhibition. Whether the good 
which sometimes follows this treatment is due to any specific effect of 
the drug is doubtful. 

In cases where prolonged mental or physical strain is to be under- 
gone, quinine in the dose of 2 to 4 grains (0.12-0.25) will often pre- 
vent exhaustion and support the system. 

The internal use of quinine is a wise procedure in whooping-cough , 
and the proper dose, according to a careful series of studies by Baron, 
is 1| grains (0.08) for each year of the child's age, to be given at 
6 a.m., 2 p.m., and 10 p.m. 

A much more agreeable method of pursuing this treatment in 
whooping-cough is to give the patient the so-called quinine chocolates, 
which contain 1 grain (0.06) of tannate of quinine and chocolate in 
each. The taste of quinine in such chocolates is scarcely noticeable 
if they are well made. 

Used in solution in the form of a spray by the atomizer, quinine is 
of undoubted service in whooping-cough, and will often prevent the 
spread of the disease to other children if they be subjected to its use. 
This solution should contain from 1 to 2 grains (0.06-0. 12) to the ounce 
(30.0) and be employed every few hours. It is well to remember 
that quinine is not tasted by the tip of the tongue, but by the back 
portion. The tip of the atomizer should therefore be carried well 
back of the root of this organ, and a 1 per cent, solution of cocaine 
painted over the dorsum of the tongue in cases where the taste 
of the quinine is objected to strongly. This solution of quinine 
used, by means of an atomizer, in colds in the head and in fetid sore 
throat is often of service. High rectal injections of quinine in the 



CINCHONA. 195 

strength of 1 : 3000 are useful in amoebic dysentery, as this drug destroys 
Amoeba coli. 

Administration. — When prescribing quinine the physician should 
employ the hydrochloride (Quininoe Hydrochloric! am, U. S. and B. P.), 
as it contains a high percentage of alkaloid and is very soluble. An 
acid hydrochloride (Quininoe H ydrochloridum Acidum) is also official 
in the B. P. The hydrochloride of quinine is stronger in alkaloid 
than the bisulphate of quinine (Quininoe Bisulphas, U. S.), which 
is, however, soluble in the proportion of about 1 to 8 of water. The 
hydrobromide of quinine (Quininoe Hydrobromidum, U. S.) is another 
useful salt, which is soluble in the proportion of 1 to 16 of water. 
The valerianate of quinine (Quininoe Valeras) possesses no particular 
value. Quininse Salicylas, U. S., is also official. The sulphate 
of quinine (Quininoe Sulphas, U. S. and B. P.), the least soluble of 
all these salts, is by custom most commonly administered. The 
tannate of quinine is a salt not so bitter as the other salts, and is 
weaker in relative alkaloidal strength. One grain (0.06) of the tan- 
nate equals about J grian (0.015) of pure alkaloid. The bisulphate 
equals about § and the sulphate f grain of the pure alkaloid. The 
dose of all the salts of quinine varies from 1 to 4 grains (0.06-0.25) 
as a tonic, and from 4 to 60 grains (0.25-4.0) for antimalarial pur- 
poses. 

The B. P. recognizes a pill of quinine, Pilula Quininoe Sulphatis, 
a tincture (Tinctura Quininoe), a wine (Vinum Quininoe), and an 
ammoniated tincture (Tinctura Quininoe Ammoniata). 

In regard to the administration of quinine, it may be said that it 
ought never to be given in solution if it can be avoided, because of its 
disagreeable taste. If it is given in solution, the liquid should be 
well acidulated, as under these circumstances it will not taste so bitter 
as when a weakly acidulated solution is employed. In adults and chil- 
dren quinine should be used preferably in small capsules or in pills, 
which may be gelatin- or sugar-coated. Another means for adults is 
the use of cachets. If pills or capsules are employed, care should be 
taken that the sugar is not hardened by age, and that the gelatin is 
thin, for if the pill or capsule escapes into the intestine before it is 
dissolved the quinine is precipitated and is not absorbed. If the case 
is that of a child too young to take a pill, the drug may be given in the 
following manner without tasting very disagreeably: 

1$ — Quininae hydrochlor. gr. xvj (1.0). 

Fluidext. glycyrrhiz foj (4.0). 

Syrupi aurantii cort f§ij (60.0). — M. 

S. — A teaspoonful t. i. d. for a child of three years. 

In some cases quinine chocolates may be used, but unless they are 
well made the after-taste of quinine is well marked. When they are 
used tannate of quinine should always be placed in them. In other 
cases quinine may be used in suppository in the dose of 2 to 3 grains 



196 DRUGS. 

(0.12-0.20), care being taken that irritation of the rectum does not 
ensue. For suppositories the best salt to employ is the hydrochloride. 
For hypodermic use the hydrochloride of quinine should be used 
most commonly, as it is soluble in about 10 parts of water, and con- 
tains more of the alkaloid than the more soluble bisulphate of quinine. 
It may be employed in the following manner: 

~fy — Quininse hydrochloridi gr. vij (0.5). 

Glycerini, 

Aquae dest aa f5ss (2.0). — M. 

S. — Warm solution before using it, and do not add acid. 

1$ — Quininse hydrochloridi gr. xv (1.0). 

Alcoholis rrixv (1.0). 

Aquae dest f 5jss (6.0).— M. 

S. — Add a few drops of hydrochloric acid to complete solution before using. 

If the bisulphate is used hypodermically, to its solution should be 
added a little tartaric or sulphuric acid to prevent precipitation of the 
drug in the alkaline juices of the connective tissues before it can be 
absorbed. The tartaric acid should be present in the proportion of 
about 1 grain (0.06) to each 5 grains (0.3) of the quinine. Should it 
be necessary to use the sulphate of quinine hypodermically, 10 grains 
(0.60) should be added to 1 drachm (4.0) of water and sulphuric acid 
added drop by drop until the salt is dissolved. The hydrobromide of 
quinine, the solubility of which is about 1 to 54 of water, may also be 
used hypodermically, as may also the bimuriate of quinine and urea 
(Quinince Bimuriatica Carbamas), which, however, is scarcely more 
than half as strong in quinine as the other salts. 

The best place to give the hypodermic injection is in the buttock, 
between the trochanter and the tuberosity of the ischium. Injections 
into the calf of the leg are very painful. 

In Italy, Baccelli has resorted to the intravenous injection of quinine 
in severe cases of malarial infection. He employs the following 
solution for this purpose: 

Tys — Quininse hydrochloridi ..... gr. xv (1.0). 

Sodii chloridi gr. xv (1.0). 

Aquoe dest fSijss (10.0).— M. 

S. — This should be injected, after an ounce (30.0^ of distilled water has been 
added to it. The solution should be boiled and filtered, and used while warm. 

As quinine in a concentrated form is a powerful heart-depressant, 
the drug should be injected very slowly into a vein of the leg when 
intravenous injections are employed. 

The alkaloids of cinchona other than quinine which are commonly 
used in medicine are cinchonidine, cinchonine, quinidine, and the 
impure substance chinoidinum. 

Cullen, Sinkler, and de Brun have all found the sulphate of cin- 
chonidine (CinchonidinoB Sulphas, U. S.) very useful in malaria, and 
it is less bitter and more soluble than is quinine. Sinkler states that 
it does not produce the severe head-symptoms caused by quinine. 



CINCHONA. 197 

The dose of quinidine sulphate (Quinidina Sulphas) is about twice 
that of quinine, as is also that of cinchonine sulphate (Cinchonina 
Sulphas, U. S.) and cinchonidine sulphate (Cinchonidina Sulphas, 
U. S.). 

Chinoidinum is a resinous mass obtained in the preparation of the 
alkaloids of cinchona, and contains amorphous alkaloids. It possesses 
distinct antiperiodic power, and was used freely when quinine was a 
very expensive drug. Its dose is three or four times that of quinine. 

The liquid preparations of cinchona are the infusion (Injusum 
Cinchona), dose a wineglassful (30.0); the tincture (Tinctura Cin- 
chona, U. S. and B. P.), one or two teaspoonfuls (4.0-8.0); and the 
compound (Huxham's) tincture (Tinctura Cinchona Composita, U. S. 
and B. P.), a teaspoonful to a tablespoonful (4.0-16.0). Huxham's 
tincture is a most efficient and elegant bitter tonic in debility and con- 
valescence from low fevers. It is too weak in alkaloids to be used 
in malarial poisoning. Under the name of elixir roborans, or Whytt's 
tincture, a similar mixture is employed for the same purposes. The 
other liquid preparation is the fluid extract (Fluidextr actum Cin- 
chona, U. S., or Extractum Cinchona Liquidum, B. P.), dose 5 to 15 
minims (0.3-1.0). A solid extract (Extractum Cinchona) is given in 
the dose of 5 to 10 grains (0.3-0.60). The B. P. preparation not 
official in the U. S. P. is the Injusum Cinchona Acidum, dose 1 to 2 
fluidounces (30.0-60.0). 

Contraindications. — Quinine is contraindicated in gastritis, cystitis, 
meningitis, epilepsy, cerebritis, and middle-ear disease, because it con- 
gests, irritates, or stimulates those areas which are diseased, and in those 
cases which have an idiosyncrasy to its action. 



CINNAMON. 

Cinnamon (Cinnamomum saigonicum vel zeylanicum, U. S. ; 
Cinnamomi Cortex, B. P.) is the inner bark of a plant, a native 
of Ceylon or of the species indigenous to China. It contains a volatile 
oil and tannic acid. In overdose the oil acts as a soporific and kills 
by failure of respiration. 

Therapeutics. — Cinnamon is used, as are all the drugs of its class, 
for flavoring, as a carminative, and as an intestinal stimulant in serous 
diarrhaas. It has the peculiar power of acting as a haemostatic in 
uterine hemorrhage where the flow is oozing and not active, thereby 
differing from the other volatile oils, with the exception of that of 
erigeron. The oil of cinnamon is a powerful antiseptic, which can be 
used in dilute form in the dressing of wounds and by injection in 
gonorrhaa. J. Chalmers Da Costa employs a spray of oil of cinnamon 
and benzoinol in the proportion of 1, 2, or 3 minims (0.05-0.10-0.20) 
of the oil to 1 ounce (30.0) of benzoinol, or it may be used by injection. 
It seems to act best in the early stages of gonorrhoea. 



]98 DRUGS. 

Cinnamic acid, a derivative of oil of cinnamon, is also used for the 
same purposes; but its chief employment has been in the treatment of 
tuberculosis. This consists in injecting hypodermically and intra- 
muscularly 2 minims (0.1) of the acid. This produces burning pain, 
which soon disappears. The patient, however, feels fatigued, has 
vertigo and cerebral congestion. Gradually the dose is increased to 
15 minims (1.0), and after several weeks the patient is said to cough 
less, to gain in weight, and to improve in physical signs. The 
treatment is so painful that it has not gained favor. 

Administration. — The dose of the oil {Oleum Cinnamomi, U. S. 
and B. P.) is 1 to 5 minims (0.05-0.3); of the water (Aqua Cinna- 
momi, U. S. and B. P.), a wineglassful (30.0) or less; of the spirit 
(Spiritus Cinnamomi, U. S. and B. P.), 5 to 30 minims (0.3-2.0); 
of the tincture (Ti?ictura Cinnamomi, U. S. and B. P.), J to 1 drachm 
(2.0-4.0). Under the name of Pulvis Aromaticus, U. S. (Pulvis 
Cinnamomi Compositus, B. P.) a carminative powder, consisting of 
cinnamon 35 grammes, nutmeg 15 grammes, cardamoms 15 grammes, 
and ginger 35 grammes, is official. The B. P. preparation does not 
contain nutmeg. Aromatic powder is useful in the treatment of the 
flatulence of adults and children. The latter should take about 10 
grains (0.60) at a dose, an adult 30 grains (2.0). 



CITRIC ACID. 

Citric acid (Acidum Citricum, U. S. and B. P.) is chemically iden- 
tical with the acid of the lemon, but has not identical influences upon 
the body as has lemon-juice. 

Not only does the lemon owe its acidity to this acid, but most of 
the other edible fruits, such as strawberries and raspberries, depend 
upon its presence for their acidity. 

Therapeutics. — Citric acid is used in scurvy, or scorbutus, as a 
prophylactic and cure. For some unknown reason, pure lemon-juice 
seems to benefit these cases more than citric acid itself, and it is there- 
fore to be preferred to the latter whenever it can be had. In order 
to keep lemon-juice from decomposition on long voyages, it should be 
boiled, and poured while hot into bottles until it nearly reaches the 
cork; the remaining space is then filled with a thin layer of sweet oil 
and the bottle corked and stood upright. Under these circumstances 
the juice may be kept indefinitely. 

In rheumatism, either acute or chronic, lemon-juice may be em- 
ployed in the dose of 1 to 2 ounces (30.0-60.0) four times a day, well 
diluted, or 2 drachms (8.0) of citric acid may be given. The acid is 
also of value in hepatic inactivity and catarrhal jaundice. (See Citrate 
of Potassium.) 

The preparations containing citric acid are Syrupus Acidi Citrici, 
U. S., Succus Limonis, B. P., and Syrupus Limonis, B. P. 



COCA AND COCAINE. 199 



CLOVES. "* 

Cloves (Caryophyllus, U. S.; Caryophyllum, P. B.) are the unex- 
panded flowers of Eugenia aromatica, sl plant of the East and 
West Indies. They possess an aromatic odor and the pungent taste 
of a typical spice. They contain a volatile oil (Oleum Caryophylli, 
U. S. and P. B.), which is yellow when fresh, but very da T k-colored 
when old. It should contain 80 per cent, of Eugenol, U. S. 

Therapeutics. — Cloves or their oil are used in medicine for their 
carminative effect. They are also employed as a stimulant and 
tonic to the stomach to prevent griping during an attack of 
diarrhea, or that caused by purgatives, to act as a flavoring 
agent, as a counterirritant, and, finally, as a parasiticide and local 
anaesthetic. 

The oil of cloves possesses great power for good in many cases of 
pulmonary tuberculosis, partly by its germicidal influence upon the 
bacillus. It should be given in the dose of 5 minims (0.3) in capsule 
after food three or four times a day, and a hypodermic injection of ster- 
ilized sweet oil, containing in each dose of 30 minims (2.0) 5 minims 
(0.3) of the oil of cloves, should be administered once a day The 
injection should be given into the subcutaneous tissues of the flank or 
abdomen, and is painful, but the decrease in the cough and expectora- 
tion amply repays the patient for the pain. 

Like all volatile oils, this oil is an efficient local application for 
Pedicidus pubis and similar parasites. It may be used in toothache 
because of its anaesthetic powers, placed on a pledget of cotton in 
the cavity of the aching tooth. In the treatment of myalgia or mus- 
cular rheumatism oil of cloves is often placed in a liniment for its 
counterirritant effect. Doses of \ to 1 minim (0.025-0.05) of the oil in 
a little water will sometimes control excessive vomiting. In addition 
to the oil the B. P. has an official infusion, Infusum Caryophylli, 
the dose of which is 1 to 2 fluidounces (30.0-60.0) 

In overdose oil of cloves acts as a soporific, and kills by failure of 
respiration and the production of severe gastro-enteritis. 



COCA AND COCAINE. 

Coca is official in the U. S. P. as Coca, and as Coca? Folia in the 
B. P.; but in the U. S. P. of 1880 it was known as Erythroxylon. 
Cocaine (Cocaina, U. S. and B. P.; Cocaince Hydrochloridum, 
U. S. and B. P.) is the alkaloid derived from Erythroxylon Coca, 
which is a shrub of Peru and Bolivia. When cocaine is heated with 
hydrochloric acid it is split into several substances, among others 
a base called ecgonine, which has wholly different properties from 
cocaine, and is perhaps responsible for some of the evil effects which 
have resulted from improperly prepared cocaine. It is to be dis- 



200 



DRUGS. 



Fig. 33. 



tinctly understood that Erythroxylon Coca is not the same as chocolate 
or Theobroma Cacao. 

Physiological Action. — Coca and its alkaloid cocaine, when taken 
internally, produce a sense of exhilaration and pleasure. Often mus- 
cular and mental power is temporarily increased under their influence. 
When locally applied to a mucous membrane, cocaine causes blanching 
followed by marked congestion. 

Nervous System. — The dominant action of cocaine, when locally 
applied to the peripheral sensory nerves, is to paralyze them (Fig. 33). 
When taken internally it stimulates the brain to an extraordinary 
degree, but exercises no effect upon the sensory nerves. Sometimes 
its internal use produces a decrease of sensation, which Mosso believes 
to be due to an influence on the spinal cord. This effect is, however, 

very feeble. If the dose be a poisonous 
one, convulsions of cerebral origin ensue, 
and are both clonic and tetanic in type. 

The sensory nerves are paralyzed by 
enormous doses both when the drug is 
directly applied and when it is taken in- 
ternally. 

Upon the muscles, when taken internally, 
Mosso has proved the drug to be a direct 
stimulant, and it is particularly active after 
starvation or fatigue. Muscular power is 
increased temporarily by cocaine. 

Circulation. — Cocaine acts as a stimu- 
lant to the heart and circulation in mod- 
erate amounts, but its effects are not 
marked except in poisonous dose. 

Respiration. — The drug acts as a pow- 
erful respiratory stimulant, producing in 
thetized by cocaine paralyzing the \ aY g e d ose a great increase in the rapidity 

ends of the sensory nerve at B. « R ~ j. i . • • 

oi the respiratory movements, but in poison- 
ous dose it kills by failure of respiration associated with exhaustion 
from the accompanying convulsions. 

Temperature. — Cocaine raises bodily temperature to an extraor- 
dinary degree if given in overdose, this rise being due to an increase 
of heat-production (Reichert). In moderate or medicinal amounts 
it has no such effect. 

Kidneys, Elimination, and Tissue-waste. — The drug is elimi- 
nated by the kidneys, but is chiefly destroyed by oxidation in the body. 
Under its influence, the quantity of urine passed is increased and the 
nitrogenous elements eliminated in this fluid are slightly diminished. 

Eye. — Owing to its powerful action as a local anaesthetic, cocaine 
has been used largely in diseases of the eye, and it is particularly effi- 
cacious in this organ because of the delicacy of the conjunctiva, which 
it readily penetrates and so paralyzes the peripheral sensory nerve- 




A, sensory nerve supplying mu 
cous membrane B, which is anses 



COCA AND COCAINE. 201 

endings. The anaesthesia comes on in from one to five minutes after 
the use of the drug, according to the strength of the solution used. 
When cocaine is applied to the eye, it causes distinct enlargement of 
the palpebral fissure and an apparent prominence of the eyeball. 
This is due to a stimulant effect of the cocaine upon the sympathetic 
nerve-fibres which supply the unstriped muscle-fibres of the lids. 
This is accompanied by marked dilatation of the pupil, which Koller 
asserts is due to constriction of the bloodvessels of the iris, the 
muscular fibres being untouched. Ophthalmologists, however, gen- 
erally assert that this mydriasis is due to the fact that the drug stim- 
ulates the peripheral ends of the sympathetic nerve. It is important 
to remember that this dilatation, unlike that produced by mydriatics, 
such as atropine, is not accompanied by paralysis of accommodation, 
and the dilatation of the pupil can be overcome at once by the use 
of eserine or pilocarpine. The drug does not cause a forcible mydri- 
asis, and is never used for the prevention of adhesions in iritis unless 
combined with atropine. 

Therapeutics. — Cocaine hydrochloride (Cocaines Hydrochloridum, 
U. S. and B. P.) is used as an anaesthetic in the eye in the dose of 
from 3 to 5 or more minims of a 1 to a 4 per cent, solution. The 
strength of 2 and 3 per cent, is perhaps most commonly employed. It 
is worth remembering that cocaine is soluble in fats, whereas its salts 
are not. Cocaine itself should therefore be used in anaesthetic salves, 
and is official for this purpose in an oleate (Oleatum Cocaines, U. S.) 
which contains 5 per cent, of cocaine. 

The conditions indicating its use in the eye are all operations of a 
painful character, and it may also be used for the relief of pain 
when an acute inflammation or foreign body is causing suffering. The 
following formula will be found useful in these states : 

1^ — Cocainse hydrochlor gr. viij (0.50). 

Acid, boric gr. vij (0.46). 

Aquae dest fgj (30.0).— M. 

S. — Use with a dropper in the eye every half hour until relieved. 

Cases of keratitis are recorded in which cocaine has produced per- 
manent corneal opacities, and it may cause dryness and roughening of 
the corneal epithelium even in the normal eye. 

Cocaine is often used in 2 per cent, solution upon cracked nipples 
just before nursing, to relieve pain. The drug must be carefully 
washed off before the baby is put to the breast. It is asserted, how- 
ever, by Guenel and Desamaux that this treatment may permanently 
stop the flow of milk. 

Owing to the density of the mucous membranes of the vagina and 
rectum, cocaine has little effect upon them unless used in 10 per cent, 
solution and freely applied. In the mouth cocaine may be used in 
cases of stomatitis where a spot is to be cauterized, in pharyngitis, 
and in soreness and tenderness of the gums. While it gives much tem- 
porary relief in pharyngitis, the subsequent effects are often exceed- 



202 DRUGS. 

ingly disagreeable, the congestion looking more angry and being more 
painful than before, and the experience of the writer indicates that it 
will only act in a curative manner if applied before the capillaries 
become relaxed or paralyzed by the severity of the inflammatory 
process. In coryza and hay fever a powder consisting of cocaine, 
morphine, and bismuth in the proportion of 1 part each of the two 
alkaloids and 5 parts of the bismuth will often be of service if snuffed 
into the nostrils. If cocaine be applied to a large nerve- trunk, am- 
putation of the tributary limb may be performed without pain, but 
so large an amount of the drug must be used that there is great danger 
of poisoning the patient. 

Cocaine is generally used at present in the place of ether in cases 
requiring amputation of the fingers or in cases of minor surgery where 
the action of the drug can be confined to the part injured. A cord 
should be tightly bound around the base of the finger and a 4 to 8 
per cent, solution injected into the part, the ligature about the base of 
the digit being used to prevent hemorrhage and systemic absorption of 
the drug. After the operation is completed slight hemorrhage should 
be allowed to occur, to sweep out the drug and thereby avoid systemic 
effect. Not more than \ grain of cocaine should be injected. When 
operations on a foot or hand have been done under cocaine anaesthesia, 
and larger amounts than this have been used, the constricting band- 
age should be allowed to remain in place some time, since the tissues 
destroy the drug, so that when the bandage is removed less is absorbed. 
(Holscher and others.) 

When a limb is to be amputated under cocaine, the main supplying 
nerve should be exposed by the aid of infiltration anaesthesia (see below), 
and then the nerve-trunk is to be anaesthetized by the injection into its 
sheath of so weak a solution of cocaine in normal saline fluid as 1 per 
cent. 

Under the name of "infiltration an&sthesia" Schleich has introduced 
a method of abolishing sensation in localized areas which often gives 
good results for minor operations. He injects into the skin, as super- 
ficially as possible, a sufficient amount of a solution of common salt, 
cocaine, and morphine to produce local oedema, and thereby pressure 
on the nerve-filaments, which are also depressed by the cold liquid 
coming in contact with them. He also believes that the local anaemia 
so caused aids in decreasing sensation. The injection is given so 
gently that a sort of wheal or cedematous spot is produced where the 
incision is to be made. As soon as this spot is developed the needle is 
inserted into its margin and carried under the skin a little farther, and 
then the injection is repeated. In this way the line of an extensive 
incision can be anaesthetized progressively. If deep incisions are 
necessary, the injections are made into the deeper tissues as well. 
The injections must always be made into healthy skin, as if it is 
diseased a slough may result. Schleich asserts that similar injec- 
tions under the periosteum permit of operations on the bones. The 



COCA AND COCAINE. 



203 



amesthesia lasts twenty-six minutes. The solution is of three strength 
as follows : 



Solution. 
Cocaine hydrochloride . 
Morphine hydrochloride 
Sodium chloride . 
Sterilized distilled water 



I. 
gr. iv(0.25). 
gr. I (0.03). 
gr. iv(0.25). 
f^iv (120.0). 



II. 

gr. ij (0.12). 
gr. J (0.03). 
gr. iv (0.25). 
fgiv (120.0). 



III. 
gr. 1 (0.012). 
gr.^ (0.006). 
gr. iv (0.25). 
f£iv (120.0). 



To each of these solutions 3 minims of a 5 per cent, solution of carbolic 
acid are added. The second solution is the one commonly used. The 
first is employed where acute inflammation 
is present, and the third where repeated 
injections are necessary. (See Fig. 34.) 

This method of producing anaesthesia has 
now been tried long enough to define its 
limits of usefulness. For minor localized 
operations it is very satisfactory; but for 
long and deep incisions it is of little value, 
as its effects are too superficial, and be- 
cause it in no way diminishes the fear 
and mental suffering of the patient, in 
whom the dread of the operation is worse 
than the actual pain. Under certain cir- 
cumstances, however, it may be used in 
major surgery, such as tracheotomy, the 
removal of small superficial tumors, and 
in those patients who are so profoundly ill 
that it is dangerous to use a general anaes- 
thetic, as, for example, in intestinal per- 
foration in typhoid fever, an operation 
which has been done many times with this 
method. As the operation proceeds the needle is inserted f e * ch su , cc f- 

, . L . . \ , . n , sive point as numbered until the 

deeper tissues are anaesthetized by mnltra- Une of anaesthesia is complete. 
tion if possible, and are cut, not torn, as 

the tearing produces great pain. Great care is necessary that the 
fluid injected is sterile. 

In some instances in which we are fearful of the effects of prolonged 
ether or chloroform anaesthesia we can use alternately ethyl chloride 
locally, infiltration anaesthesia, and, finally, the general anaesthetic 
when deeper tissues are reached and the major portion of the opera- 
tion is to be performed. Morphine may be given before the operation 
in such instances to benumb the nervous system. 

When skin-grafting is to be done, we may resort to the use of cocaine 
anaesthesia of the skin produced by the aid of cataphoresis. (See 
Cataphoresis.) 

Within the last few years cocaine and eucaine have both been used 
to produce anaesthesia of large areas of the lower portions of the body 
and limbs by injecting them into the subarachnoidean cavity below the 




Infiltration anaesthesia. 



The 



204 



DRUGS. 



Fig. 35. 



termination of the spinal cord by means of a long hypodermic needle, 
which is usually introduced between the fourth and fifth lumbar verte- 
brae. By this means the cocaine is brought in contact with the cord and 
its nerve-roots, and anaesthesia in all the tributary parts is produced. 

The operation is performed more easily with the patient in the sitting 
posture, very slightly bent forward, than when he is recumbent, but it is 
safer as far as disagreeable effects are concerned that he should be re- 
cumbent. The skin over the last lumbar vertebra is carefully sterilized 
and then infiltrated with Schleich's fluid. A long needle is then inserted 
at the side of the third or fourth lumbar vertebra in a line drawn 
between the iliac crests across the back. (Fig. 35.) It can be felt to 
pass between the bodies of the vertebrae. (Fig. 36.) If there is no 
escape of subarachnoid fluid, the needle is not in the right place. As 

soon as this fluid appears the 
syringe, already filled with a 2 per 
cent, cocaine solution, is attached 
to the needle, and from 10 to 15 
minims (0.60-1.0) are injected. 
Anaesthesia is developed in from 
two to fifteen minutes, and lasts 
from one to five hours. It is need- 
less to point out that not only the 
skin, but also the needle, the syringe 
and the solution should be most 
carefully sterilized before the oper- 
ation. This method has been 
resorted to in cases demanding 
operation below the area injected, 
and in case of labor, which is 
thereby rendered painless. Con- 
siderable fever, nervous and circu- 
latory disturbance may arise in 
susceptible persons; but Marx 
asserts that if ^ho grain (0.0003) of hyoscine is given hypodermi- 
cally these symptoms are prevented. In the opinion of the writer, 
this practice will soon cease to be employed except in a few instances 
in which some extraordinary contraindication to ether and chloroform 
exists, as it is unsatisfactory and dangerous. A number of deaths have 
followed its use. In Hahn's statistics there were 8 deaths in 1708 
operations. It would seem, therefore, more dangerous than chloro- 
form, and it is certainly not so satisfactory. The proof of its ineffi- 
ciency lies in the fact that it is not generally used. 

Internally, cocaine or the fluid extract of coca may be used as a 
temporary supportant and stimulant in low fevers, and in cases where 
great physical and mental strain must be borne. Its use for any 
length of time is dangerous and harmful. Thorington has found 
cocaine of great value in yellow fever as a stimulant for a short 




A, space between the third and fourth lum- 
bar vertebra? for subarachnoidean injection 
(Quincke's area). B, area of puncture sug- 
gested by Turner. 



COCA AND COCAINY. 205 

time and as an anti-emetic. In the vomiting o) pregnancy and other 
forms of excessive emesis it is of great service by depressing the gastric 
sensory nerves and thereby decreasing the irritability of the stomach. 
Cocaine is stated to be an antidote to morphine poisoning. 

Fig. 36. 




Showing the introduction of the needle between the last two lumbar vertebrae to produce 
spinal anaesthesia. The syringe is attached to the needle to provide a handle. After the physi- 
cian believes that the needle point is in the subarachnoid space, the syringe is detached from the 
needle in order to see if any cerebrospinal fluid escapes. If it does, this proves that the puncture 
has been successfully performed. The syringe filled with the fluid to be injected is then attached 
to the syringe and the injection given. (See Fig. 35.) 

Cocaine is undoubtedly of service in the opium habit, but if con- 
tinuously used soon evolves the patient from a morphinomaniac to 
a "coca fiend." 

The dose of the fluid extract (Fluidextr actum Coca, U. S., and 
Extractum Cocce Liquidum, B. P.) is from \ to 1 drachm (2.0-4.0) ; 
that of cocaine, from \ to| grain (0.015-0.03). The other B. P. prepar- 
ations are Lamellce Cocaina, each disk containing fa grain (0.0012) of 



206 DRUGS. 

cocaine hydrochloride, and Unguentum Cocaince and Injectio Cocaines 
Hypodermica, given in the dose of 1 to 5 minims (0.06-0.3). 

The cocaine habit is a condition unfortunately frequently met with 
since the introduction of this drug into therapeutics. It is often com- 
bined with the morphine habit, and sometimes cocaine is employed as 
a substitute for morphine. The symptoms of the cocaine habit consist 
of marked loss of flesh, disorders of the circulatory system, mental 
failure, and delusions sometimes resembling those of chronic alcohol- 
ism. Often disagreeable hallucinations are present. The habit is 
difficult to cure, for relapses are frequent. The sudden withdrawal 
of cocaine from a patient may result in profound collapse. 

According to Magnan, a pathognomonic symptom of chronic or 
subacute cocaine-intoxication is a sensation of a crawling worm or 
bug under the skin. 

Untoward Effects. — Loss of speech, blindness, nausea and vomit- 
ing, syncope, and unconsciousness have followed the internal use or 
local application of cocaine. Epileptiform convulsions have also 
been noted, while the circulation and respiration have been disordered 
in every possible manner. In many of these cases the urine passed 
after the poisoning has been copious, limpid, and contained albumin. 
Curiously enough, a large number of cases of severe poisoning have 
followed the injection of cocaine into the urethra previous to oper- 
ation for the relief of chronic gonorrhoea or stricture. 

The hypodermic injection of cocaine as a stimulant sometimes 
causes vomiting. 

The treatment of the poisoning consists in the use of ammonia, 
coffee, strychnine, or ether and alcohol if the symptoms are those of 
depression. If they are convulsive in type, then the treatment to be 
instituted is identical with that of strychnine poisoning (which see). 

Reichert asserts that morphine is the best antidote to cocaine 
poisoning. 

Of 250 cases of accidental poisoning arising from the medicinal 
use of the drug, but 13 proved fatal. 

CODEINE. 

Codeina, U. S. and B. P., is an alkaloid derived from opium, and is 
often contaminated by morphine. The sulphate of codeine (Codeina 
Sulphas, U. S.) is generally used, as it is more soluble than codeine itself. 
Codeine phosphate (Codeina' Phosphas, U. S. and B. P.) is also official. 

Physiological Action. — Codeine resembles morphine very decidedly 
in its physiological action, the chief difference being that it possesses 
less narcotizing power, but in large amount more readily produces 
tetanus and final paralysis of the peripheral motor nerves in the lower 
animals (Dott and Stockman). It does not arrest secretion in the 
respiratory and intestinal tract, as does morphine, and therefore is less 
apt to cause constipation 



COD-LIVER OIL. 207 

Therapeutics. — Codeine has been highly recommended for years as a 
nerve quietant, and in the United States in nervous cough and in 
cases where the cough is excessive in bronchitis and phthisis. In 
diabetes mellitus some clinicians have found it of value, while others 
have been disappointed in its use. It should, however, always be 
tried in this disease, in the hope that it may exercise a favorable effect. 
When given for cough it should be used in the dose of from \ to 2 
grains (0.03-0.12) three or four times a day, in the syrup of wild- 
cherry bark. When given for diabetes the dose should be much 
larger, beginning at 1 or 2 grains (0.06-0.12), and rapidly increasing 
it till the glycosuria is diminished. Sometimes as much as 20 or 30 
grains (1.3-2.0) or more may be given daily. The B. P. recognizes 
a syrup (Syrupus Codeinoe) given in the dose of 1 to 2 drachms 
(4.0-8.0). 

COD-LIVER OIL. 

Oleum Morrhuce, U. S. and B. P„, sometimes called Oleum Jecoris 
Aselli, is a fixed oil obtained from the fresh livers of Gadus Morrhua, 
or cod-fish. There are several species of cod from which the oil is 
obtained other than the one named, but that given is the chief 
source of supply. The oil is pale or dark according to its freedom 
from foreign materials, Although the paler oils are generally pre- 
scribed, there can be little doubt that the darker ones are more medici- 
nally active. The most prominent inorganic constituents of the oil are 
iodine j bromine, and sulphuric and phosphoric acids. It also contains 
more or less of the biliary salts. 

Lofoten cod-liver oil, obtained from cod caught near the Lofoten 
Islands, is generally considered the best for medicinal use. 

Physiological Action. — Cod-liver oil depends on a number of sub- 
stances for its peculiar effect. The iodine certainly exerts definite 
alterative powers, and the oil seems peculiarly adapted to digestion 
and absorption, for cod-liver oil passes through animal membranes 
very readily, probably owing to the biliary salts contained in it. 

The oil aids in the maintenance of bodily temperature by its oxi= 
dation, and causes a deposit of fat in the tissues. It also seems to influ- 
ence the blood directly, for clinical observation shows that ansemic 
persons become healthy-looking under its use, and Cutler and Brad- 
ford have found that this apparent improvement is a physiological 
fact by the use of Malassez's blood-cell-counting apparatus, the red 
corpuscles being always increased. It has been proved by experiment 
that cod-liver oil is more readily oxidized than any other oil. 

The belief among physicians that the effects of cod-liver oil are 
dependent upon some peculiar combination of substances has shown 
itself in the attempts of physiological chemists to isolate the combina- 
tion. One of the best results reached is the so-called "morrhuol' 5 ' 
of Chapoteau, who seems to have isolated a crystalline substance con= 
taining phosphorus, iodine, and bromine: 3 to 5 grains of this prepa= 



208 DRUGS. 

ration are said to represent 1 drachm of the pure oil, and it is certainly 
of value as a medicament in most of the states in which the oil itself 
is used. In "colds " which "hang on " and are not readily gotten rid of, 
morrhuol is best given in capsule or pill. This substance is put on the 
market in gelatin-coated pills or capsules. It does not possess the 
nutritive value of the oil itself. 

Therapeutics. — Cod-liver oil is useful in those persons who have no 
tubercular lesion in the lung or other tissues, but have mucous mem- 
branes which are very susceptible to disease. This state has been 
called the pre-tubercular stage of phthisis. Cod-liver oil possesses no 
curative power in cases of well-developed and rapid phthisis, and its 
administration in many cases serves only to nauseate the patient or to 
produce an oily diarrhoea through failure of digestion. It does good 
in the early stage of the disease in that it acts as a food peculiarly 
suited to a wasting malady, and its mild alterative effects are also of 
value. It maintains the patient's strength and general nutrition, and 
so favorably influences the pulmonary lesion. In chronic rheumatism 
the drug is often of great service, particularly if the disease is largely 
muscular. Strumous skin lesions depending for their existence not 
only upon scrofulosis, but also upon anaemia, often yield to its use. In 
enlargement of the lymphatic glands, where they are not undergoing 
acute active suppuration, cod-liver oil given internally does good. 
This is a statement requiring explanation. By acute active suppura- 
tion is meant the early formation of pus or the molecular death of the 
parts — not the slow formation characterized by no active change, but 
represented by cold abscess or old sores. If the suppurative process 
is chronic, the oil does good by maintaining the patient's nutrition. In 
cases of strumous ophthalmia cod-liver oil is of great service. In 
advanced syphilis cod-liver oil is most useful, and in the early stages of 
rickets it ought always to be employed. In marasmus, when used by 
inunction or given internally if the stomach will stand it, it is one of the 
best drugs we have. If a few grains of bile-salts, consisting of glyco- 
cholate and taurocholate of sodium, be added to each drachm of oil, it 
will be more readily absorbed, from the skin when applied by rubbing, 
or when taken internally. 1 At the present time capsules of cod-liver 
oil, to which has been added some bile-salts to aid in the absorption of 
the oil, can be obtained in the market. 

In sciatica and lumbago and in neuralgia cod-liver oil is of service, 
particularly if those disorders are dependent upon anaemia or an 
impoverished state of the system. In emphysema of the lungs it is 

1 These salts may be bought, or made as follows: To about 300 c.c. of ox-gall is added nearly 
thrice that quantity of ordinary alcohol, and the flask shaken thoroughly. All the mucus is now 
precipitated and the supernatant fluid is filtered. To the filtrate is added a large excess of sul- 
phuric ether, and after a time a plaster-like mass forms at the bottom of the vessel, which slowly 
becomes crystalline. These crystals are now placed on a filter-paper and washed with a mixture 
made of ether and alcohol, equal parts. The filter-paper is dried and the substances then seen 
are the taurocholate and glycocholate of sodium. Having carefully removed these salts from the 
paper, they are ready for use 



COD-LIVER OIL. 209 

said to be of value, and certain writers commend its use in gout, 
although others have asserted that it is of no value. Sometimes old 
persons, whose digestion is not disordered and who have no organic 
brain disease, complain of giddiness. The best treatment for this con- 
dition, in many cases, is cod-liver oil with small doses of quinine, or if 
these fail wine of ergot and one of the bromides may be used. 

Administration. — Owing to its disagreeable taste and smell most 
patients rebel against taking cod-liver oil; but these objections can, 
with a little persistence, be readily overcome, so that finally the patient 
may not object to the remedy, but actually like it. This is particularly 
true of young children. The secret of reaching this much-to-be-desired 
state lies in the use at first of doses which may be dropped into a teaspoon 
and the spoon then gently submerged in a glass of milk. The oil 
floats off onto the milk in a globule in the centre of the tumbler, and if 
the milk be rapidly gulped down without the oil touching the sides of 
the glass, it will not be tasted. The first gulps must be large enough to 
include the oil. The oil may be taken on a full stomach, but as a gen- 
eral rule it is best digested if taken about two or three hours after meals, 
when the gastric contents are about to be passed into the small bowel, 
where the oil is digested; and if it be immediately followed by a little 
pancreatin, its digestion will be much aided. Other modes of ingestion 
consist in the placing of the oil in whiskey or brandy, in the manner 
which has been described with milk. This method possesses the 
advantage that the alcohol by its stimulating effect aids very distinctly 
in the digestion of the oil. Sometimes a pinch of salt placed in the 
mouth before and after the oil is taken aids in masking its taste and in 
its digestion. (See Indigestion.) Oil of eucalyptus in the proportion 
of 1 to 100 of the cod-liver oil will disguise the latter's taste, but many 
persons dislike the eucalyptus more than the cod-liver oil. The 
addition of an equal quantity of glycerin, with \ to 1 minim (0.025-0.05) 
of the oil of bitter almonds to each dose, is often of service. Syrup of 
bitter orange-peel is one of the best masks to its taste. Tomato ketchup 
has also been used with good results. Chewing a piece of smoked 
herring before and after taking the oil is of value to disguise the taste 
in some cases. The oil is readily taken in soft capsules holding from 
\ to 1 drachm (1.0-4.0). Few patients are unable to swallow such 
capsules if these are first made slippery by dipping them in water. 

Cod-liver oil is most readily digested when given in single nightly 
doses after supper or after a light meal just before going to bed. After 
a few days it may be given after dinner, and in the course of a week 
after breakfast. If the patient is once nauseated by overdoses, it is 
almost impossible to make the stomach retain the oil. If there is diffi- 
culty in digestion, a drachm of ether aids in its absorption, or a drink 
of whiskey or brandy may be used instead. Often a simple bitter, 
such as a dessertspoonful (8.0) of compound tincture of cardamom, 
taken in water immediately after the oil is swallowed, aids in its diges- 
tion. 

14 



210 DRUGS. 

A large number of preparations of cod-liver oil are on the market 
in emulsion, pancreatized, and purified till they are nearly tasteless. 
Two emulsions are official in the U. S. P. of 1900: Emulsum Olei 
Morrhuoe and Emulsum Olei Morrhuce cum Hypophosphitibus, each 
containing 50 per cent, of oil, and given in the dose of 2 to 4 flui- 
drachms (8.0-16.0). Many of the permanent or perfect emulsions 
contain more Iceland moss or acacia than oil. The pancreatized 
emulsions are the best if the oil is present in sufficient quantity to do 
good, as the very fact of the oil being artificially digested adds to its 
value and makes it possible to put more oil into the emulsion. Gil 
devoid of smell is probably devoid of medicinal value, as all the 
peculiar properties have been " purified " out of it. 

Quite recently it has been suggested that cod-liver oil be given by 
the rectum, a full dose of pancreatin being mixed with it to increase 
its assimilability. Sometimes creosote is placed in this injection in 
5- to 10-minim (0.30-0.60) doses to prevent decomposition-changes 
in the oil and after absorption to a t as an c xpectorant. 

COFFEE. 

(See Caffeine.) 

COLCHICUM. 

Colchicum is the corm (Colchici Cormus, U. S. and B. P.) and seed 
(Colchici Semen, U. S. ; Colchici Semina, B. P.) of Colchicum Autum- 
nale, or Meadow Saffron, a plant of Europe, containing an alkaloid, 
colchicine (Colchicina, U. S.) which may be still further changed 
into colchiceine. The drug is official in the form of the seeds and 
root. 

Physiological Action. — Colchicum is a very powerful drug, and when 
locally applied is an irritant to the skin. Taken internally in overdose, 
it also severely irritates the gastro-intestinal mucous membrane. 

According to the studies of one of the writer's students — Dr. 
Ferrer y Leon — the drug has little or no effect when given in mod- 
erate dose on the nervous system, circulation, respiration, or tem- 
perature, producing changes in these parts only when given in poi- 
sonous doses. In full doses it greatly increases the flow of bile, and 
may cause bilious vomiting and purging. Jacobi asserts that death is 
produced by respiratory failure, the heart continuing to beat for many 
minutes after respiration ceases. The violent gastro-enteritis which is 
present in colchicum poisoning in man certainly has much to do with 
the usual fatal result. 

Therapeutics. — The employment of colchicum in medicine centres 
around its use in gout and similar states, such as chronic rheumatism. 
It is almost a specific in acute gout, provided that it be pushed until 
it causes slight griping or laxity of the bowels. Colchicum does not 
seem to possess any marked beneficial effect in preventing attacks. 
Indeed, while it relieves one attack it often seems to hasten the onset 
of the next. In acute gout it is usually well to unload the bowels by 



COLCHICUM. 211 

a small dose of compound extract of colocynth, with some hyoscyamus 
added to it to stop griping. Thus 

R — Ext. colocynth. comp gr. x vel xx (0.60-1.3). 

Ext. hyoseyami gr. ij (0.12). — M. 

Ft. in pil. No. iv. 

S. — One as soon as threatened by an attack. 

This pill is particularly needed if constipation be present and the 
belly hard. After this has acted the colchicum may be given. Thirty 
to 40 minims (2.0-2.6) of the wine of the root should be given, and 
20 minutes more in twelve hours. In some cases of subacute or chronic 
gout or chronic rheumatism, iodide of potassium should be used in 
conjunction with the colchicum. The following may be ordered: 

R — Potassii iodidi ....... 3 ss vel. 3 j (2.0 vel 4.0). 

Vini colchici seminis f.^ij (8.0). 

Vinialb q. s. f Jiij (90.0).— M. 

S. — Tablespoonful (16.0) three times a day after meals. Shake well before 
using. 

The use of colchicum in such doses as to cause severe purgation or 
emesis is dangerous, and ought not to be resorted to. Colchicine, 
U. S., can be used successfully in gout in the dose of t ^-q to -j-q grain 
(0.0006-0.0012) three times a day. There are now on the market 
capsules or pearls of colchicine with oil of gaultheria, each pearl con- 
taining from y^-q to -g 1 ^ grain (0.0006-0.001) of colchicine. They are 
very efficacious and are largely used. 

Poisoning. — The symptoms of poisioning by colchicum are nausea, 
griping, agony in the belly, purging followed by the passing of thick 
mucus, with great and increasing tenesmus, profuse salivation, col- 
lapse, and death from exhaustion and gastro-enteritis. Bloody purg- 
ing is almost never seen. The poisoning is one of the most painful, 
slow, and hopeless poisonings known, and a man taking as much as 
an ounce of the wine of the root or the seed is almost inevitably doomed 
to a terrible death. Tannic acid may be used as a partial chemical 
antidote, and the stomach washed out by the administration of emetics 
and the use of the stomach-pump. Opium is to be used to relieve the 
pain and irritation, and oils are to be given to soothe the inflamed 
mucous membrane. If collapse comes on, external heat and stimu- 
lants are to be used, and atropine may prove of service under these 
circumstances. 

Aministration. — Colchicum ought never to be used in substance, but 
should be employed in the form of wine of the seed (Vinum Colchici 
Seminis, U. S.) in the dose of 20 to 40 minims (1.3-2.6), although if a 
marked effect is required 60 minims (4.0) may be used. The extract 
(Extractum Colchici Cormi, U. S.) is given in the dose of \ to 2 grains 
(0.03-0.12) and the fluid extract of the seed (Fluidextr actum Colchici 
Seminis, U. S.) in the dose of 2 to 4 minims (0.10-0.25.) 



212 DRUGS. 



The tincture of the seed, (Tinctura Colchici Seminis, U. S. and 
B. P.) is given in 15 to 60 minim (1.0-4.0) doses. The B. P. pre- 
parations are Vinum Colchici, dose 10 to 30 minims (0.6-2.0), and 
Extractum Colchici, dose J to 1 grain (0.015-0.06). 

Colchicine (Colchicina, U. S.) is given in pill in the dose of 
to ^ grain (0.0006-0.0012). 



To"o 



C0LL0DI0N. 

Collodium, U. S. and B. P., is a solution of gun-cotton or pyroxylon 
in alcohol and ether, and is a clear, syrupy fluid, smelling strongly 
of ether. 

Therapeutics. — Collodion is used as an air-tight dressing for small 
wounds and abrasions and for rendering small dressings waterproof. 
A difficulty in its use consists in the contraction which takes place as 
it dries, which draws and puckers the parts sufficiently to cause not only 
discomfort, but also acute pain. It should be applied with a camel 's- 
hair brush. 

In boils, when they are beginning in a small pustule or papule with 
an inflamed zone, collodion painted over the spot, except at its very 
centre, will generally abort the suppuration. If the boil has burst, 
this treatment is useless; but if it has not, the pus should not be liber- 
ated, but allowed to become inspissated. By this treatment and by 
the frequent application of a coat or two the local trouble eventually 
disappears. This rule applies only to certain cases, and if pain is 
caused by the retention of the pus, it must be evacuated with antiseptic 
precautions. In smallpox the flexible collodion may be used to pre- 
vent pitting. 

In gouty inflammations of the joints an application of collodion mixed 
with iodine, equal parts, will often diminish the pain, although at first 
the suffering may be increased by this treatment. 

Flexible Collodion. 

Flexible Collodion (Collodium Flexile, U. S. and B. P.) is made 
by adding Canada turpentine 5 parts and castor oil 3 parts to 92 parts 
of ordinary collodion. It does not contract or become hard, and is 
generally to be preferred to ordinary collodion in the dressing of wounds. 

Styptic Collodion. 

Styptic Collodion (Collodium Stypticum, U. S.) contains tannic 
acid, and is employed to check small hemorrhages. It is seldom used, 
and its employment is a dirty way of controlling bleeding. 



COLOCYNTH. 213 

Cantharidal Collodion. 

Cantharidal Collodion (Collodium Cantharidatum, U. S.) has been 
referred to under the head of Cantharides. Collodium Vesicans, B. P., 
is identical with this preparation, and is used for the same purpose. 

COLOCYNTH. 

Colocynthis, U. S., is the fruit of Citrullus Colocynthis, a plant at 
present largely grown in all parts of the world. It contains an alka- 
loid, colocynthine, and a resin. Neither of these is used in medi- 
cine. Colocynth causes large watery evacuations, and may, in very 
large dose, produce fatal gastro-enteritis. It is official in the B. P. as 
Colocynthidis Pulpa. 

Therapeutics. — Colocynth is never used alone, but always in com- 
binations with other drugs of its class as a hydragogue cathartic. 

In cases of chronic dropsy and for the relief of serous effusions this 
drug is generally given in the form of the compound extract of colocynth 
(Extractum Colocynthidis Compositum, U. S. and B. P.), which con- 
tains 160 grms. of colocynth, 500 grms. of purified aloes, 140 grms. of 
the resin of scammony, 60 grms. of cardamom, and 140 grms. of soap. 
In the dose of 5 to 20 grains (0.3-1.3) this acts as a powerful watery 
purge useful in dropsy. The extract (Extractum Colocynthidis, U. S.) 
is given with other drugs in the dose of 2 to 5 grains (0.12-0.3) as a 
purge. The following is a useful form in which to administer it: 

1$ — Extract, colocynth gr. xxx (2.0). 

Extract, belladonnas gr. ij (0.1). 

Extract, nucis vomicae gr. ij (0.1). — M. 

Ft. in pil. No. x. 

S. — One each morning. 

Colocynth is one of the principal ingredients in compound cathartic 
pills (Pilula? Cathartics Composites, II. S.). Each pill contains: com- 
pound extract of colocynth, IJ grains (0.08); resin of jalap, J grain 
(0.02); and calomel, 1 grain (0.08); gamboge, i grain (0.015). This 
pill is not to be used constantly, as it eventually makes the bowels 
more constipated than before. The U. S. P. of 1900 also orders a pill 
(Pilula? Cathartics Vegetabiles, U. S.) which contains compound extract 
of colocynth, extract of hyoscyamus, resin of jalap, extract of leptandra, 
resin of podophyllin, and oil of peppermint. This is given in the dose 
of 1 to 2 pills. 

The preparations of the B. P. not official in the U. S. P. are : Pilula 
Colocynthidis Composita, composed of colocynth-pulp, aloes, scam- 
mony, sulphate of potassium, and oil of cloves, dose 5 to 10 grains 
(0.3-0.60) ; Pilula Colocynthidis et Hyoscyami, dose 5 to 10 grains 
(0.3-0.60). 



214 DRUGS. 



CONDURANGO. 



Condurango is the bark of Condurango Blanco, a tree of Colombia, 
South America. Martindale and Westcott state it is Gonolobus 
Condurango. It was introduced into medicine in 1873 as a cure for 
gastric cancer, and at one time had a favorable reputation. It is now 
known that, so far as the morbid growth is concerned, its action is 
valueless, but there is no doubt that it diminishes the severity of the 
symptoms in many cases by exercising a favorable effect on the gastric 
mucous membrane. It also tends to relieve the accompanying gastric 
catarrh through its action as a stomachic. 

The bark is never employed as the bark, but in the form of the fluid 
extract, dose 1 to 2 drachms (4.0-8.0), or the wine, dose \ to 1 ounce 
(16.0-30.0). Sometimes it is given in the form of a decoction made 
by adding 1 part of the bark to 8 parts of water, which is given in the 
dose of 1 tablespoonful (16.0) three times a day. Often it is advisable 
to add to the prescription a little hydrochloric acid to take the place of 
the natural acid of the stomach, which is usually lacking in such cases. 

CONIUM. 

Conium (U. S.) is the leaves and fruit of Conium maculatum. 
The plant grows in Europe and the United States, and contains a 
liquid alkaloid known as conine. Conium is official in the B. P. as 
hemlock-leaves {Conii Folia) and hemlock-fruit (Conii Fructus). 

Physiological Action. — Conium in full medicinal dose produces a 
feeling of relaxation and loss of muscular power, and if the dose be very 
large it causes giddiness, staggering gait, and disordered vision, with 
failure of the circulation. 

Nervous System. — Conium depresses the motor nerves, and, if 
the dose be extraordinarily large, the sensory nerves. Upon the spinal 
cord it exerts a slight depressing influence, but has no positive effect, 
while the fact that consciousness continues almost up to death shows 
that the intellectual portion of the cerebrum escapes its influence. 

Circulation. — The action of the drug upon the circulation is 
depressant. It causes at first a fall of arterial pressure; then, if the 
dose be large, a rise, due to the asphyxia caused by nervomuscular 
failure of the respiratory apparatus. Finally, a fall of pressure takes 
place. 

Respiration is depressed because of the paralytic influence of 
the drug on the nerve-trunks supplying the respiratory muscles. 

Therapeutics. — Conium holds an unimportant place in the drug-list 
of to-day. It has little value except in spasms due to irritation of a 
nerve-trunk, when it may be of service. In spasms of cortical or spinal 
origin other drugs should be used, as it is evident that conium has 
no effect in quieting the central nervous protoplasm, but only pre- 
vents the impulses which are sent out from manifesting themselves 



CONVALLARIA. 



215 



in movements of the muscles. The powdered leaves or other prepara- 
tions may be smeared over poultices to relieve the pain of ulcers and 



Fig. 37. 




cancers, arid they certainly do good in such instances. 

Administration.— The dose of the alcoholic extract (Extraction 
Conii) is from J to 1 grain (0.03-0.06), and of the fluid extract 
(Fluidextractum Conii, U. S.) 2 to 6 minims (0.1-0.4). The dose 
of the tincture (Tinctura Conii, B. P.) 
is 10 to 30 minims (0.60-2.0). Conine 
is a liquid alkaloid which should never 
be used. The dose of the hydrobromide 
of conine is said by Helbing to be |- to -§- 
grain (0.01-0.03.) The preparation in 
the B. P. made from the leaves is Succus 
Conii, dose 1 to 2 flui drachms (4.0-8.0). 
Vapor Conii consists of the juice of hem- 
lock (Succus Conii) \ ounce (15.0), liquor 
potassse 1 drachm (4.0), and distilled 
water 1 ounce (30.0). Twenty minims 
(1.3) of this mixture are placed in hot 
water in an inhaler, and so employed for 
the relief of irritative coughs or spasmodic 
asthma. Unguentum Conii is official in 
the B. P., and is used in pruritus ani. 

Tt s to be remembered that the varia- 
bility of the drug, so far as power is 
concerned, is very great — so great as to 
make it unreliable. For this reason a 
small dose should be given at first and 
the amount gradually increased. 

Poisoning. — A prominent symptom of 
poisoning by Conium is dropping of the eyelids (ptosis), due to par- 
alysis of the oculomotor nerves, and staggering and inability to walk. 
Its treatment consists in the use of strychnine as a respiratory and 
nervous stimulant, the employment of external heat, and the use of 
cardiac stimulants if the circulation fails. The stomach is to be emp- 
tied by emetics or the stomach-pump before the antidotes are used. 




conium acts as a depressant to the 
motor nerve-trunks. 



CONVALLARIA. 



This drug is derived from* the rhizome and root-stalk of Conval- 
laria majalis. It is employed in medicine as a cardiac tonic to fulfil 
the indications which direct us in the use of digitalis. While by no 
means so valuable a drug as foxglove, it sometimes acts better in an 
individual case than the older remedy. The heart is not greatly slowed 
by it, but the drug is particularly useful in cases of arrhythmia and 
"oardiac hurry." 



216 DRUGS. 

The dose of the fluid extract (Fluidextractum Convallarioe, U. S.) 
is from 4 to 8 minims (0.25-0.5) three times a day. The tincture 
(Tinctura Convallarioe) is given in the dose of 5 to 20 minims (0.3-1.3). 
Convallamarin is a glucoside of convallaria which has been used in the 
dose of \ grain (0.03) three times a day. Some clinicians think it 
ought to be given but once a day on account of the danger of cumulative 
action. 

COPAIBA. 

The Copaiba of the U. S. and B. P. is the balsam or the oleoresin 
of Copaifera Langsdorffi, and is a clear, transparent liquid of oily 
consistence, of a pale-yellow color and a peculiar odor. From it is 
distilled an oil (Oleum Copaiba?, U. S. and B. P.) which is of little 
value. 

As copaiba is an oleoresin, the term " oleoresin of copaiba" is often 
used to distinguish it from the oil. 

Therapeutics. — Copaiba is used for the purpose of stimulating the 
mucous membranes of the genito-urinary tract, particularly when they 
are depressed after a period of inflammation, as in the later stages of 
gonorrhoea. In cases suffering from chronic urethritis with anaemia and 
debility the following prescription is useful. (See also Methylene-blue.) 

1$ — Oleoresinse copaibse 5j (4.0). 

Oleoresinse cubebse gtt. iv (0.25). 

Ferri et ammonii citratis gr. xx (1.3). — M. 

Pone in capsulas No. x. 
S. — One t. i. d. after meals. 

Copaiba is employed in subacute and chronic bronchitis as a stimu- 
lant expectorant. In the treatment of subacute pyelitis, cystitis, and 
dysentery it is of value. In dropsy due to slow renal changes it is 
of service as a renal stimulant and diuretic. 

Administration. — Copaiba itself is given in the dose of 5 to 20 minims 
(0.3-1.3) in capsule or in emulsion. The oil of copaiba (Oleum 
Copaibas, U. S. and B. P.) is given in capsule or emulsion, preferably 
in the former, in the dose of 10 to 20 minims (0.60-1.3) two to four 
times a day. Sometimes it is dropped on sugar and so administered. 
Massa Copaiba?, U. S., is made by rubbing copaiba with magnesia, 
but this is a useless and clumsy way of using it in the pill form. 

The drug is eliminated in the urine, and gives the test for albumin 
with nitric acid. 

Copaiba sometimes causes urticaria, which soon disappears on 
withdrawal of the drug. 

COPPER. 

Cuprum is never used in the form of the metal itself, but chiefly as the 
sulphate, which appears in commerce as a blue, clear, somewhat 
efflorescent salt. It is soluble in 4 parts of cold water, and 2 of boiling 
water, but it is not soluble in alcohol. 



COPPER. 217 

Physiological Action. — Copper sulphate, when locally applied to a 
mucous membrane, acts as a powerful astringent, or on the surface of 
an ulcer as a mild and superficial caustic. When given in overdose by 
the stomach, it causes death by violent gastro-enteritis and exhaustion. 
Generally the symptoms do not come on for an hour, and consist in 
burning pain in the stomach, a coppery or metallic taste in the mouth, 
followed by vomiting of bluish liquids and glairy mucus. With the 
vomiting, purging comes on, the passages at first containing the con- 
tents of the intestine, and finally mucus and blood. Convulsions of an 
epileptiform character are present, and constant and profuse saliva- 
tion is not infrequent. After death fatty degeneration of the liver and 
kidneys has been noted, and it is not uncommon for jaundice to 
appear after the first twenty-four hours, if the patient survives so long. 
This jaundice is dependent upon changes in the blood. The treat- 
ment of the poisoning consists in the primary use of the chemical anti- 
dote, which is the yellow prussiate of potassium, and the administration 
of emollient or demulcent substances, such as sweet oil and white of 
eggs, followed instantly by emetics or the stomach-pump. If emesis 
and purgation are already active, emetics are of course contraindicated, 
and counter-irritation is to be employed over the stomach and intes- 
tines in the shape of a mustard plaster of moderate strength, and opium 
given to allay irritation and relieve pain. 

Chronic copper poisoning is almost never seen, and, although the 
metal is widely used for coloring canned green vegetables, it seems to be 
harmless when ingested in such small amounts. 

Therapeutics. — Sulphate of copper (Cupri Sulphas, U. S. and B. P. 
in the dose of 5 to 7 grains (0.3-0.46) may be used as a rapidly acting 
emetic which acts only upon the stomach, but not uron the vomiting 
centre. As it is irritant, the emetic dose ought not to be repeated, but 
if emesis does not occur the sulphate of zinc or mustard should be used 
to empty the stomach. Indeed, it may be said of sulphate of copper 
that it should never be given as an emetic if any other emetic can be 
found. Thornton has proved in the Laboratory of Experimental 
Therapeutics of the Jefferson Medical College that an antidotal dose of 
copper sulphate given to a dog poisoned with phosphorus may produce 
death before the phosphorus can cause a lethal result. The drug is 
therefore a theoretical but not a practical antidote to phosphorus. In 
pill form it is sometimes given in diarrheas depending upon ulceration 
of the bowels. The dose should be J to 1 grain (0.015-0.06) combined 
with opium. 

In some states of the body, particularly in skin diseases of the dry 
type and in individuals with tubercular tendencies, copper seems to 
act like arsenic, and may be used in doses of -^ grain (0.006) or 
less three times a day where arsenic is not well borne. In small 
doses it is said to be a direct stimulant to the tissues, and to increase 
the firmness of the flesh and strength of the normal man. Very 
recently strong claims for copper as a remedy for anaemia have been 



218 DRUGS. 

advanced, particularly if it is employed as the arsenite of copper, when 
the conjoint action of the arsenic and copper produces a good effect. 
Sulphate of copper in the proportion of 1 to 50,000,000 or 1 to 5,000,000 
has been proved to be exceedingly valuable for the purpose of puri- 
fying water potable except for the growth of algse, which make it 
foul. In these proportions it also destroys the typhoid bacillus, and 
it should be placed in all springs, ponds, or reservoirs which may be 
contaminated by these germs. In these quantities it is harmless to 
man and animals. 

Locally applied, sulphate of copper is useful, in the solid form or in 
powder, in the treatment of indolent ulcers. In chronic conjunctivitis 
or in cases of tinea tarsi — that is, tinea on the margin of the eyelids — a 
crystal of the sulphate may be drawn over the diseased spot; or a 
solution of 1 to 3 grains (0.06-0.20) to the ounce (30.0) of water may be 
dropped into the eye in subacute conjunctivitis. 

In relaxed sore throat, as a gargle, in the strength of 4 grains (0.25) to 
the ounce (30.0), it is often of service. 



COTARNINE. 

Cotarnine is prepared from narcotine, one of the alkaloids of opium, 
but its physiological effect is closely allied to that of hydrastinine, 
derived from hydrastis. In the form of cotarnine hydrochlorate it has 
been placed on the market as "Stypticin," and this is used as a remedy 
for oozing hemorrhages, such as menorrhagia and metrorrhagia, and as 
a local application in epistaxis. It may be given in the dose of from ^ 
to 4 grains (0.03-0.25) three times a day in pill, tablet, or elixir, or in 
capsule, or by the hypodermic syringe in the dose of 1 to 2 grains 
(0.06-0.12). 

CREOSOTE. 

Creosote (Creosotum, U. S. and B. P.), as employed in medicine, 
should always be derived from the destructive distillation of beech- 
wood and be designated "beechwood creosote." Much of that sold is 
derived from coal-tar, and is far less useful. Chemically, creosote is 
almost identical with carbolic acid; clinically, it is very different. 
Beechwood creosote is an almost colorless or yellowish liquid about as 
thick as olive oil, and possessing a penetrating odor and a burning taste. 
Its physiological action is almost identical with that of carbolic acid, 
and in poisoning by creosote the same antidotes as are employed in 
carbolic-acid poisoning — namely, soluble sulphates — should be used, 
as has been proved in experiments by the author. Creosote contains 
60 per cent, of guaiacol and 40 of cresol, not creosol. Guaiacol is 
sometimes used in place of creosote in the dose of 1 to 2 minims (0.05- 
0.10). (See Guaiacol.) Creosote is a powerful antiseptic. 

According to the studies of Imbert, creosote is eliminated chiefly by 
the kidneys in the form of guaiacol sulphate and creosol sulphate of 
potassium. Elimination is not rapid, for this investigator did net find 



CREOSOTE. 



219 



Fig. 38. 



it completed for about twenty-eight hours. A small amount, of the 
drug is eliminated by the lungs. 

Therapeutics. — During the past few years creosote has been largely 
prescribed in pulmonary tuberculosis and chronic bronchitis, and some 
of the results reached by its use have undoubtedly been of value in these 
affections. (See article on Tuberculosis.) It has also been inhaled from 
sponges with great relief, and even has been injected into the lungs by 
way of the trachea or through the chest-wall. In the treatment of 
chronic bronchitis creosote may be 
placed in boiling water and inhaled 
in the steam. Under these circum- 
stances it lessens the fetor of the 
breath, and this method often gives 
more rapid relief than any other 
measure in the treatment of ordinary 
subacute inflammation of the bronchi. 
(See Inhalations.) The beginning 
dose when the drug is given internally 
is 2 to 5 minims (0.1-0.30). 

It is useless to attempt to cure pul- 
monary tuberculosis by the admin- 
istration of creosote, and its chief 
value in the disease depends upon its 
action as an expectorant affecting 
favorably the profuse bronchial se- 
cretion associated so often with the 
involvement of the lung tissues by 
the tubercular process. Creosote 
does good, indirectly, by relieving 
this complication; but it is apt to 
disorder the digestion. It ought not 
to be employed in every case, since 

its value in relieving the bronchial disorder is far outweighed by the 
disturbance of digestion in many instances. If fever or haemoptysis is 
present, the use of creosote is contraindicated. When it is desired 
to relieve profuse mucopurulent expectoration creosote may be given 
in capsule or as follows : 

R— Creosoti (beechwood) fgiij (12.0). 

Tinct. gentian, comp fSj (30.0). 

Spt. vini rectificati i% vii (240.0). 

ViniXerici Oij (960.0).— M. 

S. — A tablespoonful in a wineglassful (16.0 : 60.0) of water three times a day. 

In other cases the creosote may be dropped into half a glassful of milk 
and taken in this three times a day. Often as much as a drachm a day 
can be given by gradually producing tolerance through ascending 
doses; and it is worthy of note that in most instances large doses are 
required if satisfactory results are to be obtained. (See article on 
Tuberculosis, Part IV.) 




Yeo's inhaler, made of perforated zinc, 
bound on the edges with chamois, and sup- 
plied with elastic loops to go back of the 
ears. On a sponge placed in front of the 
inhaler is dropped the medicament to be 
inhaled. 



220 DRUGS. 

In the advanced stages of phthisis inhalations of the drug often 
decrease the cough, relieve the laryngeal dryness, and promote expec- 
toration. When creosote is used hypodermically in phthisis, it may 
be given in the following formula: 

R— Creosoti fgij (8 0). 

Olei amygdal. express f^ij (8.0). — M. 

S. — 10 minims (0.60) to be injected deeply into the tissues below the scapula. 

This method is not to be employed except in rare cases. Indeed the 
author has jet to see a case in which its use seemed beneficial. 

In the treatment of subacute laryngitis a fine spray of 1 to 2 minims 
(0.05-0.1) of creosote, 4 grains (0.25) of menthol, and 1 ounce (30.0) 
of albolene, is of service used several times a day; or a mixture com- 
posed of creosote 10 minims (0.60), chloroform spirit 10 minims (0.60), 
and alcohol 20 minims (1.3), may be placed on the sponge of an inhaler 
and inhaled. It is also claimed that wetting cloths with creosote and 
hanging them in the air of a nursery are of great value in whooping- 
cough. (For methods, see Inhalations, Part III.) 

Sometimes creosote is given by enema in pancreatized cod-liver oil to 
children with pulmonary or peritoneal tuberculosis, in the dose of from 
5 to 15 minims (0.3-1.0). 

Creosote is a valuable remedy in cases of indigestion with fermenta- 
tive changes in the gastric contents when these arise from the deficient 
digestion of meats or the use of sweets, given in the dose of \ to 2 
minims (0.025-0.1) after meals, preferably in tablet or capsule. Applied 
on a pledget of cotton to the cavity of a carious tooth, creosote often 
relieves toothache by virtue of its anaesthetic influence over peripheral 
sensory nerves. 

While ordinary medicinal doses of creosote rarely cause disagreeable 
symptoms except some disorder of the stomach or bowels when it is 
given in full doses, the physician who is ordering large amounts 
should be always on the lookout for toxic symptoms. These consist in 
vertigo, headache, and a tendency to stupor, and the urine may become 
smoky in appearance, as in carbolic-acid poisoning. If any of these 
signs of overdosing appear, the drug must be reduced in dose or stopped 
altogether. 

The preparations of creosote are Aqua Creosoti, U. S., which is given 
in the dose of 1 to 3 fluidrachms (4.0-12.0); Mistura Creosoti, B. P., 
dose 1 to 2 fluidounces (30.0-60.0); Unguentum Creosoti, B. P., for 
local application. 

CREOSOTE CARBONATE. 

Creosote carbonate, sometimes called "Creosotal," is a combination 
of creosote with carbonic acid. Over 90 per cent, of creosote carbonate 
is said to be creosote. It is a thick, oily fluid of an amber color, with 
but little taste or odor, and is insoluble in water, dilute alcohol, and 
glycerin, but is soluble in 95 per cent, alcohol, in ether, chloroform, and 



CBOTON CHLORAL. 221 

in cod-liver and olive oils. It is said to be less irritating to the stomach 
than creosote. The drug is dissolved and absorbed chiefly in the intes- 
tine. The dose of creosote carbonate is identical with that of creosote 
itself, and it is used as an expectorant in pulmonary tuberculosis and as 
an intestinal antiseptic. It is best given in capsule. (See also Guaiacol, 
Carbonate of.) It has been claimed that this drug possesses virtue 
in cases of croupous pneumonia, but careful clinical research fails to 
show that this is true. 

CREOLIN 

Creolin is a liquid cresol, a coal-tar product, possessing marked 
antiseptic but comparatively slight poisonous properties. It is a 
dark-brown fluid, is derived from soft coal, and is of the consistence 
of syrup. When added to water it forms a white cloud and mixes 
thoroughly, forming an emulsion up to 12 per cent, of the drug. 

Therapeutics. — Creolin is used as an antiseptic in the lying-in state, 
as a wash for the hands, and for vaginal irrigation. It cannot be used 
as a solution in which to place instruments, as the mixture with water 
is so opao^e as to prevent their being seen when lying at the bottom of 
the dish. When used as a vaginal douche it should be employed in the 
strength of 2 per cent. One of its properties which is of value is that it 
forms a slippery coating over the maternal parts during parturition. 
In the treatment of cystitis in the female, Parvin highly recommended 
it as a vesical wash in the strength of a 1 per cent, solution, or, after the 
bladder becomes accustomed to its use, in a 2 per cent, solution. 
According to Kretzschmar and others, a solution of 1 to 500, used with 
a syringe, is useful in otorrhea, 1 to 100 in nasal ulcers, and 1 to 1000 as 
a nasal douche in rhinitis when there is much discharge with the forma- 
tion of crusts. Creolin has also been used as an injection in the pro- 
portion of 5 parts in 1000 of water for dysentery and colitis with success. 

In the eye Alt has used with good results a 1 to 2 per cent, solution in 
the treatment of blepharitis, keratitis, and phlyctenular ophthalmia. 



CROTON CHLORAL. 

Croton Chloral, or Butyl Chloral Hydras, B. P., has a physiological 
action closely » allied to that of chloral itself, but it possesses more 
analgesic power and is much less depressant to the heart and circu- 
lation. The dose for the production of sleep is the same as chloral, 
5 to 20 grains (0.3-1.3) in syrup. 

Therapeutics. — Croton chloral is preferable to chloral in sleepless- 
ness due to pain. 

In facial neuralgia and migraine it is exceedingly efficacious, par- 
ticularly if the fifth nerve be involved. In headaches due to eye-strain, 
and in those associated with sick stomach, but not due to gastric indi- 
gestion or nervous debility, croton chloral is of service. Curiously 



222 DRUGS. 

enough, it is valueless in toothache, but is useful in the neuralgia due 
to deayed teeth. 

Administration. — Croton chloral should be used in pill form in the 
dose of 3 to 5 grains (0.2-0.3) every two hours till the pain is relieved or 
sleep comes on, or it may be given in solution or syrup of acacia and 
water, or water and glycerin. It has been used in as large a dose as 60 
grains (4.0), but 20 to 30 grains (1 .3-2.0) ought to be the maximum dose 
as a general rule. 

CROTON OIL. 

Croton oil {Oleum Tiglii, U. S.; Oleum Crotonis, B. P.) is an exceed- 
ingly irritant oil derived from Croton Tiglium, a small tree of India. 
The oil is pale yellow in hue and of a complex character. Applied to the 
skin for any length of time, it is an intense irritant, producing blisters or 
pustules. 1 minim (0.05), placed on the tongue with 5 minims (0.30) of 
sweet oil, acts as a violent watery purge, and, owing to the smallness of 
its dose, it is frequently employed to revulse the unconscious, as in cere- 
bral congestion. In delirium it is used for the same purpose, and may 
be given to maniacs who are suffering from an attack of cerebral con- 
gestion or obstinate constipation, owing to the smallness of its dose and 
rapidity of action. The dose is 1 minim (0.05) placed on the tongue 
with sweet oil or given in emulsion or in pill. It ought never to be used 
when there is any irritation of the stomach or bowels. As a counter- 
irritant it is sometimes applied over a tender nerve or to the chest in the 
treatment of bronchitis, in the proportion of half-and-half with sweet oil. 
Thus applied, it may be absorbed and cause purging. The treatment 
of poisoning by croton oil is identical with that of gastro-enteritis. (See 
Gastro-enteritis.) Linimentum Crotonis is a preparation of the B. P. 
which is employed as a counterirritant liniment for sprains and in 
muscular rheumatism. 

CUBEBS. 

Cubebs (Cubeba, U. S., and Fructus, B. P.) are the unripe fruit 
of Piper Cubeba, a plant of Java. They are wrinkled or rough 
black bodies about the size of small peas, and have an aromatic, 
pungent taste. They contain a volatile oil, cubebic acid, and cubebin. 
The drug should not be kept in powdered form, as it loses its powers, 
but should be powdered as needed. Overdoses of cubebs cause gastro- 
intestinal and genito-urinary inflammation. 

Therapeutics. — Cubebs are used in the advanced stages of gonor- 
rhea where a tendency to a chronic discharge is present. Some sur- 
geons have used them in the early stages as an abortive treatment, but 
this is a bad practice. In cold in the head the powdered berries may 
be snuffed up the nostril when the stage of secretion is well estab- 
lished. They ought not to be used before this stage. In the treatment 
of chronic or subacute bronchitis the oleoresin of cubebs is very useful in 
some cases (see Bronchitis), and in the form of cubeb cigarettes the 
drug is much used as a remedy for hoarseness due to subacute laryngitis. 



DERMATOL. 223 

Administration. — Cubebs may be given in powder in the dose of 
10 to 60 grains (0.60-4.0), in [the fluid extract (Fluidextractum 
Cubebop, U. S.) 10 to 30 minims (0.60-2.0), and in the form of the 
tincture (Tinctura Cubeboe, B. P.) in the dose of 10 minims to \ ounce 
(0.60-16.0). 

The dose of the oleoresin (Oleoresina Cubeboe, U. S.) is 2 to 20 minims 
(0.1-1.3) three times a day, and it may be given in capsule or emulsion. 
The troches of cubebs (Trochisci Cubeboe, U. S.) are used for the relief 
of pharyngitis of a chronic type. The dose of the oil {Oleum Cubeboe, 
U. S. and B. P.) is 5 to 20 minims (0.3-1.3). 



cusso. 

Cusso, U. S. and B. P., sometimes called Kousso, is derived from 
Brayera Anthelmintica, a plant of Abyssinia. In the U. S. P. of 1880 it 
was called Brayera. It contains a volatile oil, tannic acid, and koosin 
or taeniin. The drug is used to expel the tape-worm, and is most valuable 
as a vermifuge, also possessing the advantage of safety. It should be 
used in an infusion (Infusion Brayerae) in the dose of h ounce (16.0) 
of the powdered flowers to a pint (480 c.c.) of water, and be taken in 
the morning on an empty stomach. (See Worms.) Koosin may be 
used in the dose of 20 to 40 grains (1.3-2.6) in capsule. The fluid 
extract (Fluidextractum Cusso) is given in the dose of \ ounce (16.0). 
It has been claimed that the drug is apt to cause abortion in pregnant 
women, but this is not known to be a fact. 



CYANIDE OF POTASSIUM. 

Cyanide of Potassium (Potassii Cyanidum, U. S.) is used in the same 
way and for the same purpose as hydrocyanic acid. (See Hydrocyanic 
Acid.) The dose is T V to T V grain (0.006). 

The following prescriptions may be used in cases suffering from 
bronchitis or phthisis accompanied with excessive cough : 

1$ — Potassii cyanid gr. ij (0.12). 

Morphinae sulph gr. j (0.06). 

Syr. pruni virginianse . . . q. s. ad f ^iij (90.0). — M. 
S. — Teaspoonful (4.0) three to five times a day. 

Or as follows : 

Py — Potassii cyanid g;r. ij (0.12). 

Ammon. chloridi oij (8.0). 

Elix. calisayse q. s. ad f§iij (90.0). — M. 

S. — Teaspoonful (4.0) three or four times a day. 



DERMATOL. 

(See Bismuth Subgallate.) 



224 DRUGS. 



DIASTASE. 



The word diastase is applied to substances found in certain of the 
digestive juices of the animal body and present in processes connected 
with the fermentation of grain, as, for example, in the manufacture 
of alcoholic beverages. Whatever diastase may be, we recognize 
that it belongs to the same class of enzymes as pepsin and pancrea- 
tin, and that it has the power of converting starch into sugar. Many 
preparations of malt contain some diastatic power, but there is only 
one preparation of diastase which possesses no other property save 
that of aiding the digestion of the starches — namely, one prepared 
originally by a Japanese investigator, Takamine, and called from his 
name "Taka-diastase." It is used to relieve cases of indigestion of 
starchy foods in the dose of 2 to 5 grains after meals, in tablet or 
capsule or in a solution, and is a most efficient remedy. 

A useful formula is as follows: 

1^ — Taka-diastase gr. xlv (3.0). 

Cupri arsenit gr. \ (0.01). 

Extract, nucis vomicae gr. iv (0.25). — M. 

Form in capsules No. xx. 
S. — One capsule with meals. 

Often a little capsicum may be added to this prescription, in the 
treatment of atonic dyspepsia, with advantage. 



DIGITALIS. 

Digitalis, U. S., is the leaves of Digitalis purpurea, or Foxglove, of 
the second year's growth. The leaves are official in the B. P. as Digi- 
talis Folia. It contains a number of substances, no single one of which 
acts as do preparations of the crude drug. In other words, all these 
compounds must act together to produce therapeutic effects similar 
to those obtained when digitalis leaves are given. Among the sub- 
stances so far isolated from digitalis by chemists may be named digi- 
talin, digitalein, digitoxin, digitin, and digitonin. Several of these are 
probably compounds of the others. Digitalin, so called, occurs in two 
forms, amorphous and crystalline. The crystalline digitalin (French) 
is largely digitoxin, while the amorphous form is composed of digitonin, 
digitalein, and digitalin. A pure digitalin has, however, been isolated, 
which can now be obtained from Merck. Digitoxin and pure digitalin 
are the two most active principles yet found. None of these substances 
should be used in medicine to take the place completely of digitalis, but 
digitalin may be used as a heart stimulant. 

In the early part of this volume the necessity of employing 
reliable drugs was pointed out. In the instance of digitalis this is 
particularly important, because the cases in which it is used are often 
serious, and because digitalis varies greatly in strength. As a rule, 



DIGITALIS. 



225 



the wild digitalis is stronger than the cultivated, and the English or 
German digitalis is better than the American. The preparations of 
digitalis should therefore be obtained from a reputable manufacturing 
pharmacist after they have been physiologically tested. 

Physiological Action. — Digitalis is apt to irritate mucous membranes 
which are already slightly out of order, and for this reason should not 
be given by the mouth in cases of gastritis and allied states if it can be 
avoided. 

Nervous System. — The action of digitalis upon the nervous system 
is only manifested when poisonous doses are used. Small toxic doses 

Fig. 39. 




A, digitalis stimulates the heart; B, stimulates the vagus centres; C, stimulates the peripheral 
ends of the vagi; D, stimulates the vasomotor centre; E, stimulates the walls of the blood- 
vessels. 



decrease reflex activity by stimulating Setschenow's reflex inhibitory 
centres in the medulla, and finally by depressing the spinal cord. 
Convulsions are sometimes seen as a result of the action of decom- 
position products of digitalis — namely, toxiresin and digitalresin. 
Finally, the motor nerve-trunks themselves are depressed and the 
muscles are paralyzed. 

Circulation. — Upon the circulatory system digitalis exerts its chief 
influence. In moderate or medicinal amounts it increases the pulse- 

15 



226 



DRUGS. 



force and arterial pressure, slows the pulse, and increases the size of 
the pulse-wave. The increase of pulse-force is due to a stimulating 
influence exercised upon the cardiac ganglia and the muscular fibres 
of the heart; the rise of arterial pressure is caused by the increase in 
pulse-force and pulse-volume, and by a stimulation of the vasomotor 
centre and the muscular coats of the bloodvessels, whereby a con- 
traction occurs in the walls of the arteries and arterioles. The slow 
pulse is produced by stimulation of the pneumogastric centre and the 
peripheral ends of the vagus nerves. The increase in the volume of 
the pulse is due to this influence on the vagi, for, the pneumogastric 
nerves being stimulated, the diastole of the heart is more full and com- 



Fig. 40. 



I 

\AAA/yyV\M/\ 


II 


f 


III 


AnJ^\ 



Showing the effect of digitalis on the circulation. (After Schmiedeberg.) I. Before digitalis 
was used: blood-pressure 86, pulse 21 in ten seconds. II. After the use of digitalis: blood- 
pressure 150, pulse 22 in ten seconds. III. After another dose: blood-pressure 164, pulse 20. 
IV. After another dose: blood-pressure 210, pulse 40. 



plete and occupies a greater length of time. The result of this delay is 
that the ventricles become thoroughly distended, and on contracting 
drive out a much larger wave of blood through the aorta than is nor- 
mally sent out (Figs. 39 and 40). This is important to remember when 
using the drug in heart disease and other states. While it is not known 
that the vagi are the trophic nerves of the heart, there is a large 
amount of evidence in favor of such a view, and it has long been thought 
that digitalis was not only a heart stimulant, but a remedy that increased 
the growth of its muscular tissue as well. If the trophic nerves of the 
heart are stimulated by digitalis, it becomes evident that it is a doubly 



DIGITALIS. 227 

useful remedy. 1 (See the article on Heart Disease in Part IV. of 
this volume for a further explanation of the influence of digitalis in 
improving the nutrition of the heart muscle.) 

When full medicinal doses of digitalis are repeatedly given, or when 
poisonous doses are ingested, the action of the heart becomes exceed- 
ingly irregular, hobbling, and dicrotic. (See Poisoning.) What the 
cause of this irregularity is we do not know. It is certainly not due to 
weakness, for the cardiac beats, when they occur, are in themselves 
more forcible than in health. The probable explanation of this peculiar 
cardiac irregularity lies in a disturbance of the co-ordinating apparatus 
of the various parts of the heart muscle. By this the author does not 
refer to the so-called co-ordinating centre of Kronecker and Schmey, 
which probably does not exist, but to the changes which may take 
place in the so-called " contraction wave," which is found to begin in 
the normal heart at the great veins and passes from them through the 
auricular walls to the walls of the ventricles. It has been found by 
Wooldridge and by Tigerstedt that if the auricle and ventricles be 
separated by a ligature or clamp, they still continue beating, but no 
longer do so synchronously, or, in other words, the centres of each set 
of walls act independently of the others. The irregular action of the 
heart under digitalis is probably dependent upon a disassociation of 
these centres ; and this theory is substantiated still farther by the experi- 
ments of Roy and Adami, who have proved that independent con- 
traction of the various parts of the heart can be produced by stimula- 
tion of the peripheral end of the cut vagus, a part of the nerve which is 
stimulated by digitalis in the large doses which we have been consider- 
ing. In man this irregular pulse is replaced sometimes by an ex- 
ceedingly rapid pulse, which is shuttle-like in character; and whether 
the pulse be irregular or rapid, the arterial pressure is always low, 
owing, first, to the imperfect action of the heart, and, second, to a 
depression of the vasomotor centres and the muscular coats of the 
bloodvessels. The rapid pulse, when it occurs, is probably due to a 
depression of the peripheral ends of the vagus nerves. 

In the frog digitalis causes, when given in full doses, systolic arrest of 
the heart, but in man the arrest is in diastole. 

If a patient who has taken a poisonous dose be suddenly placed in 
an upright posture death may ensue, owing to the disturbance of the 
contraction-wave in the heart produced by the erect posture. Under 
these circumstances the heart beats so abortively that the circulation 
fails. 

Respiration. — Digitalis has almost no effect on this function unless 
the amount be poisonous, when respiration is slowed. 

Temperature. — Upon the normal bodily temperature digitalis has 
little or no effect in medicinal dose. In poisonous dose it lowers tem- 

1 In an original study by the author he found that when digitalis is given continuously for a 
long period of time there results cardiac hypertrophy independently of any valvular lesion. See 
Therapeutic Gazette, December, 1897. 



228 DRUGS. 

perature. In fever the drug seems to cause a slight fall with some con- 
stancy, but it can rarely be used for any antipyretic influence. High 
temperatures prevent digitalis from slowing the pulse, because, as proved 
by Brunton and Cash, fever depresses the vagus centres in the medulla, 
and also in all probability, when the temperature is very high, the 
peripheral ends of the vagus. This is an important point to be remem- 
bered in the therapeutic use of this drug. 

Kidneys, Tissue-waste, and Elimination. — Digitalis has almost 
no effect upon the kidney structure itself, and does not to any extent 
stimulate the renal epithelium. The cause of the increased urinary 
flow produced by digitalis in cases of cardiac dropsy depends upon the 
removal of congestion of the kidneys and the increased arterial pressure 
and improved circulation brought about by the drug. 

It is important to remember that digitalis, if given in overdose, may 
cause a spasm of the bloodvessels of the kidney, and so cause sup- 
pression of urine. This is usually followed by the development of 
cumulative effects. 

Upon tissue-waste digitalis seems to have little effect, but there is 
still some discrepancy in the reports as to the amount of urea excreted 
under its use, some investigators saying it is increased, others that it 
is diminished. 

It is not known how the drug is eliminated, as chemists have never 
been able to detect it in the urine. It is probably oxidized in the body. 

Poisoning. — The slow, full pulse, followed by the hobbling, dicrotic, 
shuttle-like pulse-beats, and the angry, tumultuous cardiac beat afford 
a combination of symptoms characteristic of the overaction of digi- 
talis. The pulse may be full and slow when the patient is recum- 
bent, but at once becomes irregular on his sitting up. 

As the poisoning progresses vomiting may come on, exophthalmos 
occurs, and a peculiar blue pearliness of the sclerotic is seen. Con- 
sciousness is generally preserved nearly to the last. Death from digitalis 
poisoning may not take place for days or may occur in two hours or 
even less. Headache is often a severe symptom. 

Treatment of Poisoning. — Tannic acid is to be given as a chemi- 
cal antidote; emetics and the stomach-pump are to be used, the former 
only when the drug has not been absorbed, for if the heart is much 
affected emetics are dangerous. External heat is to be applied, particu- 
larly about the abdomen ; the maintenance of a horizontal position must 
be insisted upon for several days after active symptoms have subsided, 
for sudden death on sitting up has occurred. The use of tincture of 
aconite, as the physiological antidote, may be resorted to. 

Therapeutics. — Much misunderstanding concerning the action of 
digitalis has arisen, and, while some call it a circulatory stim- 
ulant, others think it a circulatory depressant. The first class base 
their belief on the signs of increased arterial pressure and cardiac power, 
the others on the fact that it slows and steadies an irritable, rapidly 
acting heart but overlook the other signs. Digitalis is a cardiac 



DIGITALIS. 229 

stimulant, and not a depressant. The quieting of irritability by it is 
the quietness produced by the drink of whiskey or coffee taken by 
the pugilist before he enters the ring, to steady his nerves and make 
him firm. If digitalis is used to decrease arterial tension, its dose 
must be dangerously large. (See Physiological Action.) 

Digitalis is of value in all cases of cardiac disease where the con- 
dition is one in which the heart fails to do its proper amount of work. 
If simple hypertrophy or excessive compensatory hypertrophy exists, 
it is harmful. It is of less value in aortic regurgitation than in any 
other lesion, because the prolongation of diastole allows greater oppor- 
tunity for the bldbd to fall back into the ventricle, although in the 
second stage of this lesion, when the mitral orifice and valve are begin- 
ning to be affected, it is often very useful. In some instances of mitral 
regurgitation the drug does harm by overdistending the auricle through 
ventricular stimulation, which results in an increase in the regurgitant 
flow, and we can never tell before trying it which cases will be so 
affected. In cases where the heart is irritable, palpitation present, and 
indigestion not the cause of the trouble, digitalis is of service. (See 
Heart Disease. 1 ) It is also useful in cardiac dilatation and asthenia, 
and in that condition which Da Costa called a " tired heart." 

In the second stage of pneumonia if the heart is laboring and unable 
to do its work properly, digitalis is often invaluable (see Pneumonia), 
and as a heart tonic during the course of exhausting fevers, in small 
doses, is of great service. In congestion of the lungs in the typhoid 
state it will drive out the blood from the part congested and relieve 
stasis unless the temperature is so high that it cannot act. 

In cardiac weakness from collapse, injury, poisoning, or shock digi- 
talis is of service, particularly in aconite poisoning, in which it is the 
physiological antidote. Owing to its tardy action it should, however, 
be preceded by ammonia and alcohol where the need is pressing. 
In muscarine poisoning digitalis and atropine are the antidotes. 

As a diuretic digitalis is most useful when the kidneys are congested 
and the circulation is sluggish from cardiac feebleness. When the renal 
structure is diseased, other drugs should take its place, or it should be 
combined with more active renal remedies, such as squill or caffeine, or 
with compound spirit of juniper in very chronic cases of kidney trouble. 

As digitalis acts very slowly and maintains its effect for a long time, 
it may be given only once a day after its effects have been obtained, 
for the purpose of continuing its influence. 

Often when the patient has by error received too much of the drug 
the finger can scarcely note any pulse at the wrist, yet the ear when 
placed over the heart finds it to be beating wildly, as though it would 
break out of the chest. It is important that the weak pulse at the 
wrist be not taken as the only guide as to the state of the patient for 

1 It is absolutely necessary for the student to turn to the article on Heart Disease, and to 
read it carefully, in order to understand the action of digitalis in disease. 



230 DRUGS. 

this very reason, and the physician should always auscult the prsecor- 
dium before reaching an opinion as to the action of digitalis. 

Untoward Effects. — Digitalis sometimes causes nausea and indigestion 
by irritating the stomach. In children it is very apt to produce marked 
irregularity of the pulse. When given in full doses, the patient should 
always remain in bed and not be allowed to sit up suddenly, as syncope 
may occur. It is particularly important that this rule be enforced if the 
patient desires to empty the bladder, for cases are on record in which 
a patient has risen suddenly, emptied the bladder, and fainted or even 
died in syncope. 

In some cases a cumulative action occurs, which consists in a sudden 
development of the effects of the drug to an excessive degree, so that 
the symptoms resemble those seen after a poisonous dose has been 
taken. This is particularly prone to occur when ascites or dropsy is 
removed by tapping after the drug has been taken for a long period. 
It is thought that the sudden withdrawal of pressure upon the great 
vascular trunks of the body-cavities causes the absorption of the drug 
with the juices of the tissues where it has remained inactive. Such 
an accident also sometimes occurs when a fever ends by crisis and 
digitalis has been given. It also takes place whenever full doses are 
given so frequently as to be in excess of elimination, for the drug is 
slowly eliminated, and so rapidly accumulates in the body. Cumu- 
lative action is often preceded by a scanty passage of urine. A decrease 
in the quantity of the urine when digitalis is being used should cause 
the physician to stop its administration or be most cautious in its con- 
tinuance. 

Contraindications. — In cases of marked atheroma of the bloodves- 
sels, in aneurism and apoplexy digitalis is a dangerous drug, because it 
raises arterial pressure, and it is because of this effect that it is harmful 
in the presence of arterial excitement. In fatty degeneration of the 
heart the remaining healthy muscular fibres of this organ are, it is 
true, stimulated by the drug, but at the same time it also increases 
arterial tension to such an extent as to increase the labor of the failing 
heart. 

Administration. — The official preparations of digitalis are the tincture 
(Tinctura Digitalis, U. S. and B. P.), dose 5 to 30 minims (0.30-2.0); 
the infusion (Infusum Digitalis, U. S. and B. P.), 1 to 4 drachms 
(4.0-16.0); the fluid extract (Fluidextractum Digitalis, U. S.), dose 1 
to 4 minims (0.05-0.25); the extract (Extractum Digitalis, U.S.), J 
grain (0.015); and the powdered digitalis leaves (Digitalis Folia, 
B. P.), dose 1 to 4 grains (0.06-0.25), generally given in a pill. 

Some choice should be exercised in the use of the various prepara- 
tions made from digitalis leaves, because the different active ingredients 
of the drug possess different solubilities and exert different effects on 
the circulation. Thus digitalin, digitoxin, and digitalein all act as 
powerful stimulants to the heart muscle. Digitalin also stimulates 
the vagus peripherally and centrically. All three of these raise arterial 



DIGITALIS. 231 

pressure by stimulating the vasomotor system peripherally and eentri- 
eally. Digitonin, on the other hand, does not stimulate the heart 
muscle, but rather depresses it. It also depresses the vagus, and thereby 
somewhat antagonizes the digitalin, 1 digitoxin, and digitalein. 

If we now turn to a consideration of the solubilities of these prin- 
ciples, we can readily explain the different effects produced by the 
infusion and tincture or fluid extract. Digitonin is soluble in water, 
as is digitalein; but digitalin is only slightly soluble and digitoxin is 
scarcely at all soluble in water. As a result, the use of the infusion 
in a case of heart disease would not give the patient the same degree 
of cardiac power as the use of the tincture, for not only would the 
most powerful stimulant of all to the heart, vasomotor system, and 
vagi — namely, digitalin — be present in small amount, but in addi- 
tion the large proportion of digitonin would antidote it. On the other 
hand, digitonin is sparingly soluble in alcohol, while digitalin and 
digitalein are readily soluble in it, digitoxin being slightly so. It would 
seem, therefore, that in the presence of a failing heart and circulation 
the tincture and the fluid extract are the preparations greatly to be 
preferred to the infusion, because they contain large amounts of the 
active stimulant ingredients. 

The reason that the infusion acts efficiently as a diuretic in some 
cases probably depends upon the fact that as it does not contain so 
much digitalin it is less apt to cause spasm of the renal vessels ; but if 
the heart is feeble and there is renal stasis, the tincture is probably the 
better preparation to overcome this state, because it both aids the heart 
and by contracting the renal vessels overcomes the stasis. The use 
of digitalin is inadvisable unless we are sure that we get that made 
according to the process of Schmiedeberg, for the other digitalins usually 
sold are very uncertain. The infusion is far more apt to disorder the 
stomach than the fluid extract or tincture, because of the irritating 
digitonin. The dose of digitalin, which ought not to be used as a sub- 
stitute for digitalis, is -^ grain (0.001). 

When digitalis cannot be swallowed there is little, if any, use in 
giving any of the official preparations hypodermically for they are 
precipitated in the tissues. Digitalin may be used at such a time. 
Its absorption may be brought about by the use of a poultice made 
by placing some digitalis leaves in a small bag and steeping it in hot 
water. The bag is then placed over the loins. This plan of treat- 
ment must be cautiously employed to avoid poisoning, because we 
cannot tell how much digitalis is absorbed. 

Attention has been called to the necessity of using a preparation 
which has been subjected to a physiological test by the manufacturer 
before it is placed on the market. This is important because the 
crude drug varies so greatly in strength that even the most careful 

1 By digitalin, reference is made to that prepared by Merck, and sometimes called the digitalin 
of Schmiedeberg, and not the amorphous form of Homolle nor the crystalline digitalin of Nativelle. 



232 DRUGS. 

pharmacist cannot be sure that each lot of leaves is of equal medicinal 
strength, and chemical analysis of its complex make-up is practically 
impossible. Often when a patient has been taking an ordinary prepa- 
ration of digitalis without good results the writer has seen the use of a 
physiologically tested and active preparation do much good. Under 
the name of " Digitalone " Houghton has devised an excellent liquid 
preparation of digitalis suitable for use by the mouth or hypodermic 
needle, since it represents the full therapeutic value of the drug and 
is readily absorbed without causing irritation, which is not true of 
tincture of digitalis. The dose is from 5 to 20 minims (0.30-1.3). 

DIURETIN. 

(See SODIO-SALICYLATE OF THEOBROMINE.) 

DORMIOL. 

This drug is closely related to chloral, being a compound of chloral 
and amylene hydrate, and is a colorless fluid, tasting somewhat like 
camphor and being slightly pungent to the oral mucous membrane. 
It is miscible with water, and is marketed in 50 per cent, watery solu- 
tion, which is further diluted by 4 additional parts of water when it is 
prescribed. It is used as a hypnotic, as its name indicates, and as a 
substitute for chloral, but is probably not so powerful as a sleep- 
producer. Its dose is J to 1 drachm (2.0-4.0) of the 10 per cent, 
solution just named, which may be mixed with syrup of raspberry, 
or water, to dilute it if desired. 

DUBOISINE. 

Duboisine is the alkaloid of the leaves of Duboisia myoporoides, a 
plant of Australia. The crude drug is little used in medicine, but 
duboisine sulphate is used as a mydriatic under the same conditions as 
is atropine, and more largely still as a hypnotic in insanity, inter- 
changeably with hyoscine. The dose of duboisine sulphate hypodermi- 
cally as a hypnotic is -£$ to -^ grain (0.0008-0.001). The clinical 
experience so far adduced would seem to indicate that it tends to 
decrease urinary secretion and to disorder the digestion, producing at 
the same time a soapy taste in the mouth, with excessive dryness of the 
mucous membranes. Rarely it causes profuse salivation or sweating 
in those who have an idiosyncrasy to its use. In a large number of 
insane and hysterical cases de Montyel found its use was followed by 
vomiting of part of the food, but the patients seemed to have no nausea. 
The sulphate has been used with much asserted success in the treat- 
ment of paralysis agitans. Usually the dose by the mouth for this pur- 
pose has been yj-g- grain three times a day. Cividati and Gianelli 
assert that duboisine is useful in epilepsy, particularly in its psychic 
forms. 



ERGOT. 233 

ELATERIUM. 

E later lum, B. P., is a sediment obtained from the juice of Ecballium 
Elaterium, or squirting cucumber. It appears in small, friable, thin, 
grayish-green flakes, having a bitter taste. Elaterium is not official 
in the U. S. P., but its active principle, elaterin (Elaterinum, U. S. 
and B. P.), is official. Notwithstanding this fact, the crude drug is 
largely used. 

Physiological Action. — Elaterium is a decided irritant to all mucous 
membranes, and even to the fingers of those who handle it. Its chief 
effect when taken internally by man is to cause profuse watery stools, 
but for some unknown reason it rarely acts upon animals in this 
manner. 

Therapeutics. — This drug is the best hydragogue purge which we 
have, causing large watery passages, but not producing much pain 
when used in proper dose. For this reason it is useful in the treat- 
ment of local serous effusions, as in pericarditis and pleurisy, and in 
dropsy and ascites or general anasarca. It ought never to be used in 
cases of marked exhaustion, and may be advantageously followed, 
soon after it acts, by alcoholic stimulants. In uraemia with dropsy it 
is thought to aid in the elimination of the uraemic poison by the bowel. 
In cerebral congestions or effusions the drug is of service by depleting 
the diseased vessels. 

In poisoning by elaterium the symptoms are those of violent gastro- 
enteritis, and must be treated accordingly. (See Gastro-enteritis.) 

Administration. — The dose of elaterium is J grain (0.01), given in a 
freshly made pill. Elaterin is best given in the dose of from -^ to -^ 
grain (0.003-0.006), as follows: 

Py — Elaterini gr. iv (0.25). 

Alcoholis fgiv (120.0).— M. 

Dissolve by gentle heat. 
S. — Half a drachm contains T ^ grain (0.004), or one full dose. 

The official preparation of elaterin, the active principle of elaterium, 
is Trituratio Elaterini, U. S. (elaterin 1, sugar of milk 9), given in the 
dose of \ to 1 grain (0.03-0.06). Pulvis Elaterini Compositus, B. P. 
(elaterin 1, sugar of milk 39), is given in the dose of 1 to 5 grains 
(0.06-0.3). 

ERGOT. 

Ergota, U. S. and B. P., is derived from the spawn or mycelium of 
the fungus known as Claviceps purpura, which grows in the flower 
and replaces the grain in common rye, or Secale cereale. 

Many so-called active principles have been isolated by chemists, 
and named ecbolic acid, ergotic acid, sclerotinic acid, and ergotin. 
None of these represent the entire drug, the nearest in its approach 



234 



DRUGS. 



Fig. 41. 



being ergotin, and ergotin is not an isolated principle, but a com- 
bination of principles. Robert teaches that there are three principles 
— namely, ergotinic acid, cornutine, and sphacelinic acid — and that 
cornutine is a true alkaloid. Further, that it is upon this cornutine 
and sphacelinic acid that the chief activity of the drug depends. Tan- 
ret, on the other hand, denies the existence of cornutine as an alkaloid. 
Physiological Action. — Nervous System. — Upon the nervous sys- 
tem ergot exercises little, if any, effect. 

Circulation. — Ergot when injected into the circulation causes a 
primary fall of arterial pressure, followed by a slight rise. The domi- 
nant action is represented in the rise. This 
rise is due to a stimulation of the vasomoter 
centres, but the primary fall is caused by its 
direct depressant effect upon the heart muscle, 
resulting from the direct contact of the drug 
en masse with the heart. If the dose be very 
large, and the fall of pressure is not recovered 
from, progressive paralysis of the vasomotor 
apparatus and heart occurs. When given in 
medicinal doses by the stomach the drug causes 
a rise of arterial pressure, chiefly by an action 
on the heart and the muscular coats of the 
bloodvessels. 

Uterus and Unstriped Muscular Fibre. 
It has been commonly taught that the contrac- 
tions of the uterus produced by medicinal doses 
of ergot are due to the stimulating influence 
of this drug upon the muscular fibres of this 
organ; and while this is probably the case, it 
is also a fact, as shown by the careful studies 
a, ergot stimulates the of Hemmeter, that the drug causes uterine 
uterine centres in the spinal contractions by stimulating the centres in the 

cord, and B, the muscular 1 •, ,- * ,i • i 1 i • 1 

fibres in the uterus itself . lumbar portion of the spinal cord which con- 
trols this viscus. 

On the uterus ergot in full medicinal dose exerts its influence not by 
increasing the normal pains of labor, but by causing a tetanic, tonic, 
unyielding uterine spasm which drives all before it. In very small 
doses it may assist the normal contractions without causing them to 
become tetanic. 

Ergot acts as a stimulant to all unstriped muscular fibres. 

Acute Poisoning. — The symptoms of overdosing from ergot, when 
the effects are slowly produced, are sometimes great hunger or craving 
of food, at other times nausea and vomiting, If the poisoning is quite 
severe, there are great restlessness, headache, delirium, and coldness 
of the surface of the body. 

Chronic Poisoning. — Two forms of poisoning from the prolonged 
use of ergotized rye bread sometimes occur. One is characterized by 
spasmodic muscular contractions, the other consists in the formation 




ERGOT. 235 

of gangrenous sloughs. In the first of these forms it is not very uncom- 
mon for cataract to develop, and it is stated that the spams are due to 
the influence of one of the principles of ergot — namely, cornutine. 

Therapeutics. — Ergot is given to parturient women for the prevention 
or arrest of post-partum hemorrhages. For the prevention it should be 
given to the woman by the mouth just as the head of the child is about to 
slip over the perineum, and not before, but in the majority of instances 
its use is needless. When administered to check a hemorrhage already 
flowing, the doses should be large, as much as 1 to 2 drachms (4.0-8.0) 
of the fluid extract or 1 wineglassful (30.0) of the wine of ergot. The 
drug should produce its effects in about fifteen minutes, and may be 
repeated every fifteen minutes till it acts. The action lasts about half 
an hour. Ergot should not be given in the early stages of labor, but 
this rule may, under certain conditions, be modified. If uterine inertia 
comes on in the course of a normal labor, which cannot be overcome by 
the use of coffee or kola, or other nerve-stimulant, a small dose of ergot 
may be employed. Such a small dose does not cause a constant tetanic 
uterine contraction, but simply brings on the " to-and-fro " movements. 
By a "small dose" the writer means from 5 to 20 minims (0.30-1.3) of 
the fluid extract. Caution must be used even with this dose. 

If the birth-canal is obstructed, ergot should never be employed, 
and, unless the os uteri is well dilated, should not be given in any 
dose. 

In post-partum hemorrhage of a severe character it is well to give 
ergot aseptic or ergone hypodermically. " Ergot aseptic " is dis- 
pensed in sealed and sterile glass bulbs, and is a concentrated 
preparation of ergot intended for hypodermic use. Each bulb holds 
one dose, and the drug is drawn directly from it into the syringe. 
This is a most useful preparation. 

When ergot is given, care should be taken that the uterine cavity 
is free from all clots or placental fragments, lest closure of the 
os uteri under the influence of the drug imprison these harmful 
materials. 

According to many obstetricians, whose results have been confirmed 
by a number of special studies, ergot in moderate doses very distinctly 
aids in overcoming subinvolution of the uterus. 

In hemorrhages from the lungs and kidneys or other unapproachable 
parts ergot is thought by some to be very useful when given by the 
mouth, but it is probable that it rarely achieves any good. Par- 
ticularly is this the case in pulmonary hemorrhage, since a vaso- 
motor system practically does not exist in the pulmonary vessels, and 
the increased pressure caused by the ergot in the general systemic cir- 
culation may increase the pulmonary leakage. The truth is, that in 
pulmonary hemorrhage little real good can be obtained by internal 
medication. 

In epistaxis, menorrhagia, and metrorrhagia, and in some cases of 
night-sweats, ergot is of service. In hypostatic, pulmonary, and other 
congestions it is useful, particularly if employed with digitalis. 



236 DRUGS. 

In dysenteries with bloody stools and in serous diarrhoea ergot some- 
times does good. 

Some persons suffer from vertigo associated with hyperesthesia of 
the scalp and headache. Relief can often be obtained in such cases by 
the use of 20 minims (1.3) of the fluid extract of ergot and 5 to 10 grains 
(0-30-0.60) of bromide of potassium three times a day. 

Ergot has been used very largely in the treatment of uterine fibroids 
as an expulsive remedy and cure. It is only of value in those cases 
where the growths are just beneath the mucous membrane. By the 
contractions of the uterine muscular fibres the blood-supply of the 
growth is decreased, the recurring hemorrhages cease, and the tumor 
is finally expelled, having sloughed out of its bed. This method is 
far inferior to the knife, and very painful and prolonged. Large 
growths cannot be so treated. Ergot is sometimes useful in the treat- 
ment of bleeding hemorrhoids, and it has been given with success in 
diabetes insipidus, when it is well to combine with it the bromide of 
sodium. 

Administration. — Ergot is official as the fluid extract (Fluidextractum 
Ergota;, U. S.) ; Extractum Ergotw Liquidum, B. P.), dose J to 1 drachm 
(2.0-4.0); and the extract (Extractum Ergotw, U. S. and B. P.), dose 
5 to 30 grains (0.30-2.0). The wine (Vinum Ergotw) is given in the 
dose of 4 to 8 drachms (16.0-30.0). Bonjean's ergotin is made by a 
special process, and it or the solid extract can be given hypodermically 
if ergot aseptic cannot be had. The B. P. preparations are In- 
fusum Ergotce, 1 to 2 fluidounces (30.0-60.0), and Injectio Ergoto? 
Hypodermica, B. P., given in the dose of 3 to 10 minims (0.20-0.60) 
by subcutaneous injection. The B. P. also recognizes an ammoniated 
tincture of ergot (Tinctura Ergots Ammoniata). Ergotin (Ergotinum) 
is given in the dose of 2 to 5 grains (0.12-0.30). 

As ergot is a drug that varies greatly in physiological activity in 
its crude state, and cannot be chemically assayed with advantage, the 
physician should always use a preparation which has been physiologi- 
cally tested by the manufacturer before it is placed on the market. 
This may be done by studying its effect on the uterus of a pregnant 
animal, or by giving it to animals and observing its effect on the calibre 
of the small vessels. If the drug is active, it causes stimulation of the 
muscular coats of the vessels; and if its use is persisted in, it finally 
occludes them. Houghton has shown that an active ergot will cause 
gangrene of the rooster's comb if it is given constantly. Inert ergot 
will not do this. Much credit is due to Houghton for having per- 
fected this valuable pharmacological test. 

ERIGERON, or FLEABANE. 

Oil of Erigeron (Oleum Erigerontis, U. S.) is a yellowish volatile oil 
of a peculiar, not unpleasant, taste, closely resembling that of tur- 
pentine, which is distilled from the fresh flowering herb of Erigeron 



ETHER. 237 

canadense. It is by far the best medicinal remedy for the treatment 
of passive uterine oozing, or a "show," as it is sometimes called. 
In epistaxis and other hemorrhages of moderate degree it is useful. 
In some instances it is used in place of copaiba and cubebs in the 
later stages of gonorrhoea. It is best given in capsule or on sugar in 
the dose of 10 to 30 minims (0.60-2.0) after meals, or oftener if needed. 



ERYTHROL TETRANITRATE. 

(See article on Nitroglycerin.) 

ETHER. 

Sulphuric ether is official as /Ether, U. S. and B. P., and in the U. S. 
Pharmacopoeia of 1880 was called Mther Fortior. Pure ether {Mther 
Purificatus, B. P.) is practically free from alcohol and water. Ordinary 
ether is not generally used as an anaesthetic, but for the abstraction of 
oils and for other pharmaceutical purposes. Ether is made by the 
action of sulphuric acid on ethylic alcohol, and is sometimes called, in 
consequence, ethyl oxide. Ordinary ether contains about 74 per cent, 
of ethyl oxide and 16 per cent, of alcohol, with a little water. On the 
other hand, the stronger or official ether contains about 96 per cent, of 
ethyl oxide and 4 per cent, of alcohol, with water. Both prepara- 
tions boil when held in the hand in a test-tube if a piece of broken 
glass is added to the liquid. The stronger ether boils much more 
vigorously than the weaker under these circumstances. 

Ether is a colorless, volatile, and very inflammable liquid possessing 
a peculiar penetrating odor, a hot, burning taste. For this reason it 
should never be held near a fire or light, and, as its vapor is heavier 
than air, any fire in the room should be above the patient, not below 
him. No flame should be held nearer to the ether than five feet. 

Physiological Action. — The action of ether on the animal organism 
is very rapid and powerful, but temporary. Except for the rapidity of 
its effects it is very much like that of alcohol. When applied to the skin, 
it causes intense cold by its evaporation, and may be used in the form 
of a spray to benumb or locally freeze a part. 

Upon mucous membranes ether as a liquid or in vapor acts as an 
irritant, and causes, when its vapor is first inhaled, great irritation of 
the fauces and respiratory tract, so that temporary arrest of respiration 
is not uncommon. The face becomes suffused and red and the conjunc- 
tiva injected. Owing to these conditions the patient often is restless or 
struggles to move his face away from the vapor, but a stage of quiet soon 
succeeds this primary stage of struggling. During this period of quiet 
the breathing is generally full and deep and the pulse rapid but strong, 
while the ocular reflexes are at its beginning intact. Following this 
stage a second period of restlessness or struggling may come on, In 
which the patient becomes absolutely uncontrollable except by brute 



238 



DBUGS. 



force. Yelling, shouting, cursing, or laughing and crying, may be 
prominent symptoms, and the individual is pugilistic, caressing, or 
ill-tempered, according to his temperament. If the drug is now pushed, 
a condition of total anaesthesia is soon attained, and quietude takes 
the place of the struggles. This is the time for the operation to be 
carried on, for if it is attempted in the earlier stages the struggles of 
the second stage prevent any operative procedures. (See Therapeutics, 
below.) It is not proper to push the drug till the muscular relaxation 
amounts to complete flaccidity, as this endangers the respiration. 

Nervous System. — In producing its effects, ether acts first on the 
brain, then on the sensory tracts of the spinal cord, then on the motor 
tracts, then on the sensory side of the medulla oblongata, and finally 



Fig. 42. 




B 





-E 



Ether produces anaesthesia by depressing the perceptive areas in the brain, A. Later it 
depresses the intellectual areas, B, and the motor areas, C. After this the sensory paths in the 
spinal cord are depressed, D, and finally the motor tracts in the cord, E. 

upon the motor side of the medulla, and thereby produces death from 
respiratory failure if given to excess. Upon the nerve-trunks it exerts 
no effect unless it is directly applied to them. Ether does not produce 
anaesthesia by influencing the blood, coagulating the protoplasm of the 
nervous system, or by any other destructive influence. It simply 
inhibits, for the time being, the vital functions of the parts affected by it. 

The anaesthesia from ether develops when the ether vapor is present 
in the blood serum in the proportion of 1 to 400. 

Circulation. — Ether is one of the most diffusible and rapidly act- 
ing cardiac stimulants which we possess, and is correspondingly fleet- 
ing in its effects. It increases the pulse-rate and force by stimulating 
the heart and the arterial pressure by increasing the activity of the vaso- 
motor centres. In overdoses it acts as a cardiac depressant, but only 
when the amount is very large. Upon the blood, the author's col- 



ETHER. ' 239 

league, J. Chalmers Da Costa, has shown that ether, when given by 
inhalation, decreases the haemoglobin richness of each corpuscle, 
although there is an apparent increase in the number of the corpuscles 
themselves, particularly in those persons who are already somewhat 
anaemic. 

Respiration. — As already stated, when ether is first inhaled it 
often causes arrest of respiration. According to Kretzschmar, this 
is due to an irritation of the trifacial nerve, which causes a reflex spasm 
of the glottis, and not to irritation of the peripheral vagi in the lungs. 
This is only partly true, for the author has proved that section of the 
vagus nerves prevents this occurrence, so that both the vagal and tri- 
geminal irritations are responsible for the arrest. 

In patients under ether the movement of the diaphragm is an exceed- 
ingly interesting study, for before the condition known as surgical 
anaesthesia is developed, while there is still some rigidity and the 
throat reflex is not completely abolished, the contractions of the dia- 
phragm are frequently so violent that unless the laryngeal opening 
be absolutely free the intercostal spaces are depressed and the abdomi- 
nal contents thrust violently downward and outward. Just so soon, 
however, as the chin is pulled forward and a free access of air is allowed, 
the abdominal displacement, though it is still present, is not so great, 
and the chest movement is no longer reversed. As the ether is pushed 
the respiration becomes purely thoracic, the diaphragm no longer 
taking part in the respiratory cycle, or becoming so relaxed that it 
allows the chest on expansion to aspirate the abdominal viscera upward, 
as is shown by the retraction of the belly-walls at a time when they 
should normally expand with the thorax in inspiration. This obser- 
vation would seem to point to the fact that the primary stimulant 
action of ether upon the respiratory apparatus is particularly felt by 
those centres which govern the movements of the diaphragm, and 
that, as this is the case, these centres later are the first to feel the 
paralyzing effect of still larger amounts of the drug. 

These facts give us, therefore, a danger-signal during the adminis- 
tration of ether, and the integrity of the diaphragmatic function, as 
represented by the movement of the belly-walls, should be as care- 
fully observed as are the thoracic excursions, the character of the 
pulse, or the condition of the pupil. The rule may therefore be laid 
down that when the diaphragm ceases to act anaesthesia has been 
carried to its extreme legitimate limit, and that the use of an anaes- 
thetic after this time must be carried on with the greatest care and 
watchfulness. 

The diaphragm is the first part of the respiratory mechanism to 
yield to respiratory paralysis. In death from any cause the progress 
of failure of respiration will, in the vast majority of cases, be denoted 
by a failure on the part of the diaphragm primarily, with compensa- 
tory excursions of the chest ; and it is also to be noted that as the chest 
movements fail the accessory muscles of the neck come into play. 
These muscles in time cease to act, the hyoidean group lose their point 



240 DRUGS. 

d'appui, the chest remains motionless, the lower jaw is dropped, and 
the scene is closed by a few gasps in which the muscles of the neck 
may be the chief factors. 

Upon the respiratory centre ether acts as a powerful stimulant when 
used in ordinary amounts; in overdose it paralyzes this part of the 
nervous system. 

Temperature. — Prolonged etherization lowers the bodily heat very 
greatly. That of the dog may be lowered some 9° F. in an hour 
if the drug be pushed, and as great a fall has been known as 4° F. 
in man. The fall is partly due to the depression of the nervous 
system and the chilling of the body and lungs by the evaporation of 
the drug. 

Elimination. — Ether escapes from the body by the lungs and 
kidneys. 

Untoward Effects. — Ether, while safer than chloroform, is not abso- 
lutely devoid of dangerous effects. 1 Sometimes, when the drug is 
pushed too strongly, deep cyanosis with pulsation of the jugular veins 
shows deficient oxygenation of the blood and cardiac distention. In 
other, very rare, instances sudden cardiac failure has occurred or total 
arrest of respiration ensued. In nearly all cases of sudden death from 
ether grave kidney or heart lesions have been found at the autopsy. 
Rarely the rise of arterial pressure which it produces has caused 
apoplexy. 

The treatment of accidents during etherization consists in the with- 
drawal of the ether, the use of artificial respiration, and the placing 
of the body, if the face is pale, head downward. On the other hand, 
if the face is flushed and cyanotic it indicates respiratory, not cardiac, 
failure, and this position is not to be resorted to. The physician should 
also employ hypodermic injections of strychnine, atropine, and digi- 
talis, or, more rarely, an intravenous injection of ammonia, which is 
more dangerous, but better than the others in a pressing emergency 
because it is more rapid in its action. Ether is often given hypoder- 
mically under such circumstances, and may occasionally do good; 
but its use is a bad practice, as, if the heart or respiration is already 
depressed by ether, the employment of still more of the drug simply 
makes matters worse. The cases in which such a line of treatment 
is followed by good results are those in which the failure of respiration 
is not due to a saturation of the body with ether, but to asphyxia pro- 
duced by mechanical interference with free breathing, as, for example, 
the presence of mucus in the air-passages or a too close application 
of the towel to the face. In such cases the hypodermic injection of 
ether causes so much local pain and irritation as reflexly to excite 
respiratory movements, as well as to stimulate directly the respiratory 



1 The mortality due to etherization is about 1 in 20,000; or, according to the combined statistics 
of Julliard and Ormsby, in 407,553 cases there were 25 deaths, or 1 in 16,302, (Compare Chloro- 
form.) 



ETHER. 



241 



centre to greater effort. 1 Alcohol ought not to be used if the other 
drugs named can be obtained, because alcohol is so nearly allied 
physiologically and chemically to ether. Frictions, hot applications, 
and artificial respiration should be practised. (See article on Asphyxia.) 
The diaphragm being the most important muscle of respiration, the 
physician should seek to stimulate it by resorting to Laborde's rhythmic 
traction of the tongue, which consists in rhythmically drawing this 
organ outward and upward from the mouth ten to fourteen times a 
minute. 



Fig. 43 




Illustrating how traction on the tip of the tongue draws the epiglottis away from the glottic 
opening and permits free ingress of air. Also showing how letting the tongue fall back in the 
mouth in anaesthesia would close the air-passages and permit the epiglottis to interfere with 
breathing. For a full description see article on Asphyxia. (From a research by Martin and 
the author.) 

As ether is at hand, it may be dashed on the chest and abdomen to 
cause inspiration by reflex action; in lieu of cold water, which wets 
the clothes and does not evaporate rapidly. 

In some cases great nausea and vomiting follows the use of ether. 
This can generally be prevented by the avoidance of food for twelve 
hours before the operation, and by the administration of cracked ice 

1 As consciousness is not necessary to the carrying out of a reflex action, this is perfectly possible 
and probable. 

1G 



242 



DRUGS. 



Fig. 44. 



and small doses of acetanilid and brandy after the operation. (See 
Vomiting.) This condition may also be avoided in many cases by 
giving oxygen gas with the anaesthetic. (See Oxygen, Important.) 
Severe bronchitis may occur in invalids and children after the inhala- 
tion of ether, and in many cases this is due more to the exposure than 
the drug. Pulmonary complications, while possibly due to the direct 
effect of the ether, are probably chiefly the result of the inspiration 
of particles of food, foul secretions from the mouth, and perhaps 
blood, into the lungs, the glottis being anaesthetized and unable to 
protect the lungs from the invasion of foreign matter. Great cleanli- 
ness of the mouth is essential before every operation, and care should 
be taken during and after the operation that profuse secretions are not 
inspirated. 

Total or partial anuria may develop after etherization, particularly 
after abdominal operations. This is a very dangerous symptom, 
which can sometimes be removed by giving nitroglycerin and a large 
rectal injection of normal saline solution. It has, however, been 
proved, both experimentally and clinically, that ether is not capable, 
in the ordinary patient, of producing renal disorder of any moment 
unless the kidneys are already diseased or the patient is soaked with 
the drug, as sometimes occurs when it is improperly given. Weir asserts 

that ether is not dangerous even in those 
with moderately diseased kidneys. The 
employment of ether in diabetic patients 
is dangerous; the patient often never re- 
gains consciousness after its use. 

Not uncommonly after the use of ether 
in the case of an old person or a child the 
bronchial tubes so fill with mucus that 
there is danger of the patient drowning 
in his own secretions. A full dose of atro- 
pine, which checks secretion, given hypo- 
dermically is useful at such times. 

Sometimes after an anaesthetic is given 
the patient is found to have a monoplegia. 
This is not due to the anaesthetic, but to 
pressure exercised upon the nerve supplying the part during the opera- 
tion. It is a true pressure-palsy. 

Therapeutics. — Ether is used chiefly as an anaesthetic by means of 
inhalation. One method consists in forming a cone out of a towel 
and a piece of paper and placing a small sponge in its apex. Upon 
this sponge the ether is poured, and the large open mouth of the cone 
is placed over the face. If this be done suddenly, the sensation of 
suffocation is generally so great as to cause fright and struggling, 
which is inadvisable. The better way is to hold the cone at some dis- 
tance from the face, and gradually bring it nearer as the effects of the 
ether are developed. As the vapor of ether is heavier than air, it 




Allis inhaler. 



ETHER. 243 

falls over the patient's face in concentrated form, even if the distance 
between the inhaler and the patient amounts to several inches. There 
is therefore no justification in applying the cone to the face at the very 
beginning of the inhalation. After partial anaesthesia is attained the 
cone should be placed closely over the face and the vapor be pushed in as 
concentrated a form as possible, whereas when chloroform is used its 
vapor should be well mixed with a great amount of air. Care should 
be taken that the ether does not get into the eyes of the patient, either 
in vapor or liquid form, owing to the irritation which it will set up. 
To prevent this a piece of thin muslin wet with water will be found 
of service if placed over the eyes. A large number of ether-inhalers 
are employed in preference to the towel; the best is that known as the 
"Allis Inhaler," fitted with a web of muslin. (See Fig. 44.) (For the 
use of oxygen with ether, see Oxygen.) Much of the irritation of the 
upper respiratory passages produced by ether may be avoided by 
wetting the inhaler with a drachm or two (4.0-8.0) of an alcoholic 
solution of menthol (50 per cent.). 

When ether is to be given no food ought to be allowed the patient 
for twelve hours preceding its use, in order to avoid vomiting during 
and after the operation. The patient should not be allowed to retain 
any tobacco or artificial teeth in the mouth, as either may slip into 
the larynx and cause death while the anaesthetic is being given. 

Under the name of the A. C. E. mixture there is used a compound 
of alcohol, chloroform, and ether, which is properly but rarely used 
in America. (See Chloroform.) 

Ether may be used as a local anaesthetic in an atomizer spray, 
owing to the cold produced by its evaporation when it strikes the skin. 
Thus it is particularly useful in cases where thoracentesis or 'paracen- 
tesis abdominis is to be performed, and also in cases of superficial 
neuralgia, where the benumbing of the nerve often effects a permanent 
cure. 

Internally, by the stomach, ether is very useful in colic, although 
for -flatulence of adults and children Hoffmann's anodyne is a more 
efficient remedy. In cases of collapse ether given by means of the 
hypodermic needle or by the stomach is of great service, particularly 
when cardiac action is very feeble, and it will give relief by inhalation 
in some of these cases more rapidly than the nitrite of amyl. 

In hiccough a few inhalations of ether will often stop the spasmodic 
movements, and other local muscular spasms can be relieved in this 
way. In other instances a few drops scattered over the belly wall 
may arrest it. 

Large doses of ether given by the mouth or hypodermically have 
been highly recommended in the treatment of uraemia. They are 
most serviceable in the forms in which cardiac and respiratory com- 
plications are marked. 

Ether may be used by inhalation to produce muscular relaxation 
when the surgeon desires to reduce a strangulated hernia by taxis, 



244 DRUGS. 

In cases where cod-liver oil cannot be digested ether may be given 
in 20-minim (1.30) doses in ice-water or capsule, either with the oil, or 
some minutes after it is taken, to aid in its digestion and absorption. 

Internal Administration. — When used internally, ether should be 
given in ice-cold water, or, better still, in capsule, in the dose of 30 
minims to \ ounce (2.0-16.0). If cold water is not used to dilute 
it, so great is the irritation of the fauces produced by the fumes of the 
drug that deglutition is impossible. 

The B. P. recognizes a spirit (Spiritus Miheris) given in the dose 
of 1 to 2 drachms (4.0-8.0). 

Contraindications. — Ether should not be used by inhalation in bron- 
chitis or acute nephritis, because of its irritant properties; in perito- 
nitis or gastritis, because it is apt to induce vomiting; in aneurism or 
in the presence of marked vascular atheroma, because it may rupture 
a bloodvessel by raising arterial pressure; nor in diabetes, lest it pro- 
duce diabetic coma; and if anaemia is present and an examination of 
the blood shows that the haemoglobin is below 50 per cent., the use 
of the drug should be avoided if possible. 



ETHYL BROMIDE. 

Bromide of Ethyl is obtained by distilling a mixture of alcohol, 
sulphuric acid, and bromide of potassium, and is a colorless fluid of 
neutral reaction, having a pleasant odor resembling chloroform. It 
evaporates with great rapidity, and any sample which does not do 
this is to be discarded. Poured on the hand, it should leave no fatty 
feeling. It should be remembered that the drug is decomposed by 
sunlight and when in contact with the air. In the presence of lamp- 
light the fumes form bromal hydrate and bromine. The drug should 
be kept in dark-glass bottles. The physician should distinctly sepa- 
rate in his mind bromide of ethyl from bromide of ethylene. The 
latter is a chemical product possessing very dangerous properties, and 
should never be used in medicine. There is reason to believe that 
unfavorable symptoms follow the use of bromide of ethyl only when 
the drug is impure or is improperly used. 

Physiological Action. — According to the studies of Thornton and 
Meixell in the author's Laboratory at the Jefferson Medical College, 
the dominant action of the bromide of ethyl is on the respiratory, not on 
the circulatory, system. This effect is depressant, but this influence is 
only met with after excessive doses. The blood-pressure falls under its 
influence to a slight degree, and the pulse is slowed through an influence 
probably exercised on the inhibitory nervous mechanism of the heart. 

Therapeutics. — Bromide of ethyl is a useful anaesthetic for short 
operations, such as opening boils or abscesses, or for the relief of the 
pain in other brief surgical procedures. Originally introduced into 
general use in this country by Levis, it has been found unsuited to 



ETHYL CHLORIDE. 245 

major surgical cases, because if continued for a long time it seriously 
depresses the respiration. Bromide of ethyl has been found of the 
greatest value by Montgomery, of Philadelphia, as an anaesthetic in 
labor and for minor gynecological operations in office practice. He 
finds that the patient may be allowed to inhale the drug from a Haw- 
ley inhaler, for as soon as she has had enough to produce anaesthesia 
the inhaler drops from her hand. The patient is also more obedient 
to the physician's directions, because of the fleeting influence of the 
drug, than when chloroform or ether is taken, and post-partum 
hemorrhage through uterine relaxation is not so apt to occur. 

A very great advantage possessed by bromide of ethyl is the rapidity 
of its action. A few whiffs are generally all that is needed to cause 
anaesthesia. It rarely produces disagreeable effects. Cases of sudden 
death under its use are, however, on record, and in some instances 
nervous twitchings, and even tetanic spasms, have been known to 
follow its employment. These tetanic symptoms are, however, fleet- 
ing and generally of little importance. Nausea and vomiting rarely 
follow its employment, but it is apt to leave an unpleasant garlic-iike 
taste in the mouth, and a similar odor of the breath is frequently noted 
for several days after its use. 

Administration. — Bromide of ethyl should be administered for but 
a brief period, but when taken should be inhaled freely. It cannot 
be given carelessly with good effect. If a good sample is employed, 
45 minims to 3 drachms (3.0-12.0) is a sufficient amount to induce 
anaesthesia. This quantity should be used at once, instead of added to 
the inhaler drop by drop, as in the case of chloroform, and the cloth or 
inhaler should be held close to the mouth and nose, instead of at a little 
distance, as is often necessary with other anaesthetics. 



ETHYL CHLORIDE. 

Ethyl chloride is a liquid of a strong etherea. odor, made by the 
action of hydrochloric acid upon ethylic alcohol. It is used in the 
form of a spray, as is methyl chloride, for the purpose of producing 
anaesthesia by freezing the part of the body with which it is brought 
into contact. This liquid is used not only as a local anaesthetic by 
virtue of its freezing properties, but also by inhalation. It is neces- 
sary when it is given by inhalation, because of its great volatility, 
that it should reach the patient in concentrated form, and not have 
an opportunity to be dissipated into the surrounding air without first 
entering the lungs. For this reason it should be used by the aid of 
a mask such as that employed in the administration of nitrous oxide 
gas. The mask should be applied in such a way as to cover tightly 
the nose and mouth, and the ethyl chloride is then projected on to a 
compress which is placed inside of it. Where it is impossible to obtain 
an inhaler made for this purpose, a tin or glass funnel may be used 



246 



bRUGS. 



as a substitute. The large end of this may be placed over the mouth 
and nose, the neck of the funnel containing absorbent cotton. Through 
the small end of the funnel the chloride of ethyl is sprayed upon the 
cotton. By the careful adaptation of the hands to the sides of the 
funnel and the cheeks it is possible to make this a very close inhaler. 
A good way to keep ethyl chloride is in the form of a graduated 
glass container so constructed that the drug is measured as the spray 
is forced from it by the heat of the hand. The drug 
is placed upon the market for this purpose in gradu- 
ated glass containers, under the name of "Kelene." 
Anaesthesia produced by this method usually develops 
within a verv few moments, and it is claimed that 



Fig. 45. 



Hp- 


50 






31= 


4C 


I'- 


-30 


ll. — 


i 


!-— 


- 1 


|j— 


-2( 


^Jr^ 


-id 


Hfe 


i 


«ft2E 


*j 



Fig. 46. 



The cap unscrews and 
the drug escapes as a 
fine spray through a 
small hole in the end of 
the glass. 




Showing use of a glass funnel as an inhaler for ethyl chloride. 



there are very slight changes in the pulse and respiration under its 
influence. One or 2 drachms (4.0-8.0) of ethyl chloride are usually 
sufficient to produce an anaesthesia lasting from five to ten minutes. 
Larger amounts than this may be employed when a longer anaesthesia is 
desired. It is a noteworthy fact that the pupillary and corneal reflexes 
are not lost under its influence except in children, and this drug cannot 
be used as an anaesthetic where muscular relaxation is indispensable. 
After the mask is removed the patient rapidly recovers consciousness 
and often experiences no unpleasant symptoms, although vomiting 
may occur in some cases. It is, so far as is yet determined, a safe 
anaesthetic. A disadvantage of this form of anaesthesia is its cost. 



EUCAINE HYDROCHLORATE AND LACTATE. 247 

In 2550 cases recorded by Lotheisen 1 death occurred under its effects, 
but this may have been due to organic disease of the coronary 
arteries, which was present. Seitz has collected 1600 cases with 1 
death due to disease of the coronary arteries. 



ETHYL IODIDE. 

Ethyl Iodide is a colorless, non-inflammable liquid, which should 
be called hydriodic ethyl. Ethyl iodide must be kept in dark-colored 
bottles in a dark place to prevent it from undergoing decomposition. 
It is very volatile, and the fumes arising from it are slightly pungent, 
but not irritating in ordinary amounts. Unfortunately, the odor is 
disagreeable to most persons. 

Physiological Action. — Very little is known of the general physio- 
logical action of iodide of ethyl, and the drug would be a good one for 
laboratory investigation. It does not produce anaesthesia except in 
very large amounts. 

Therapeutics. — Iodide of ethyl is used in medicine entirely by inhala- 
tion for the treatment of subacute or chronic catarrh of the air-passages 
and for the purpose of rapidly impressing the system with iodine for 
alterative purposes, for it is the iodine in the remedy which produces 
the curative effects desired. In catarrhal states of the bronchial 
tubes the stimulating effect of the iodine is supposed to cause free 
secretion and to prevent abnormal thickening of the mucus and dilata- 
tion of the air-passages. For this reason iodide of ethyl is supposed 
to be of service in asthma and its resulting emphysema. Bartholow 
recommended this drug in the treatment of pneumonia. It was said by 
that writer to be particularly useful in the later stages of this disease, 
to aid in producing resolution, but the author has never seen it pro- 
duce much effect. (See Inhalations.) 

Administration. — 10 to 20 minims (0.65-1.3) may be placed upon 
a handkerchief and inhaled, or a small vial filled with the drug may, 
be held in the hand under the nostrils. Under these circumstances 
the heat of the hand sets free the necessary amount of vapor. 



EUCAINE HYDROCHLORATE AND LACTATE. 

Eucaine hydrochlorate is a synthetic substance having a chemical 
formula closely resembling that of cocaine. The drug is now mar- 
keted as a substitute for cocaine, it being claimed that it does not 
affect the heart as does the latter drug. Eucaine does not cause a 
primary contraction of the bloodvessels when locally applied, as does 
cocaine, but a hyperemia of the parts affected. Two forms of eucaine 
have been used, eucaine "A" and eucaine "B"; but the latter is now 
employed for ordinary local anaesthesia, and for use in ophthalmic and 
genito-urinary surgery, as it is less irritating. Used by the process 



248 DRUGS. 

for producing infiltration anaesthesia (see Cocaine) , eucaine causes con- 
siderable pain before acting as an anaesthetic. For infiltration it 
should be used dissolved in the following formula and warmed before 
being injected: 

~fy — Beta-eucain gr. j (0.06). 

Sodii chloridi . . gr. x (0.60). 

Aquae destillat fgiij (90.0). 

In ophthalmic practice it is employed in 2 per cent, solution, and to 
ordinary mucous membranes in 5 per cent, solution — that is, 25 grains 
(1.6) to the ounce (30.0) of water. One advantage of eucaine is that it 
forms a permanent solution with water in 3J per cent, strength. Fur- 
ther, eucaine solutions can be boiled and thereby sterilized before they 
are used without causing decomposition of the drug. 

Recently eucaine lactate has been introduced to take the place of 
the hydrochlorate, as it is very much more soluble, namely, to the 
extent of 25 per cent. 

Eucaine hydrochlorate possesses a distinct disadvantage in its 
inability to cause primary contraction of the bloodvessels when locally 
applied, and this effect of cocaine is often most valuable to overcome 
local engorgement. Further, it causes severe smarting pain when 
dropped into the eye. Eucaine is also capable of producing internal 
effects resembling those due to overdoses of cocaine, and these must 
be treated by the use of strong coffee, alcohol, digitalis, and strychnine. 
If the case is urgent, ether, ammonia, and nitroglycerin may be used 
as rapidly acting stimulants. 



EUCALYPTUS. 

Eucalyptus, U. S., is the leaves of Eucalyptus globulus, or Blue- 
gum tree, a native of Australia, but grown at present all over the world. 
Its chief medicinal constituent is the oil of eucalyptus {Oleum Eucalypti, 
U. S. and B. P.), from which is derived Eucalyptol, U. S., which is a 
camphoraceous body obtained by redistillation with caustic potash 
or chloride of calcium. The oil of eucalyptus and eucalyptol are used 
for the same purposes, but the latter is the refined product of the 
former. 

Physiological Action. — Locally applied, the oil is a decided irritant. 
10 to 20 minims (0.60-1.3) taken internally cause slight stimulation, 
followed by a sense of calm ; while larger doses produce disturbed diges- 
tion and loose, oily-odored stools. The pulse is increased in frequency 
and force, and intense headache may come on. After very large 
doses there is a fall in pulse-force, bodily temperature, and strength 
of limb, and the respirations are decreased. A peculiar loss of sen- 
sation in the lower limbs may occur. If death takes place, it is due 
to respiratory failure. The drug is eliminated by the skin, kidneys, 



EUONYMUS. 249 

bowels, and lungs. The urine may have the odor of violets, as it 
sometimes does after the use of oil of turpentine. 

The oil of eucalyptus has considerable antiseptic power. 

Therapeutics. —Eucalyptus is used in malarial fever where quinine 
cannot be had nor be borne by the patient owing to idiosyncrasy. In 
bronchitis in an emulsion or in capsule, it is of great value in the later 
stages (see Bronchitis), since in its elimination by the lungs it acts 
locally upon the inflamed mucous membrane, and it may be used in the 
subacute forms of gonorrhoea in the same manner. The following pre- 
scription will answer: 

1$ — Olei eucalypti . foj (4.0). 

Olei amygdalae express foj (4.0). — M. 

Ft. in capsule No. x. 

S. — One t. i. d. after meals. 

Oil of eucalyptus is very useful in some forms of rheumatic headache 
or in headache dependent upon malarial fever. 

Eucalyptol, U. S., is obtained from oil of eucalyptus, and is largely 
employed by rhinologists and others in lotions and other nasal appli- 
cations. It may be used in solutions of fatty oils, but is insoluble in 
water, although it is soluble in alcohol and ether. 

Administration. — The fluid extract (Fluidextr actum Eucalypti, U. S.) 
is given in the dose of 10 minims (0.60) to 2 drachms (8.0), the oil 
{Oleum Eucalypti, U. S. and B. P.) in the dose of 5 minims (0.30). 
The dose of eucalyptol is 5 grains (0.30) in capsule. 

Trochiscus Eucalypti Gummi and Unguentum Eucalypti are official 
in the B. P., but are seldom used. 



EUDOXINE. 

Eudoxine is the bismuth salt of nosophen. (See Nosophen.) It 
occurs as an odorless, tasteless, insoluble, reddish-brown powder, 
containing less than 60 per cent, of iodine. Eudoxine is employed in 
medicine as an intestinal antiseptic and antifermentative. It is used 
in the diarrhoeas of children in the dose of \ to 5 grains (0.03-0.3), 
and given to adults for the same purpose in the dose of 5 to 20 grains 
(0.3-1.3). The range of usefulness of this drug is much the same as 
bismuth in such cases, except that it is less astringent, but more anti- 
septic and alterative. Because of the latter influence it is indicated 
in subacute chronic catarrhal inflammations of the bowels. 



EUONYMUS. 

Euonymus, U. S., Euonymi Cortex, B. P., or Wahoo, is the bark of 
Euonymus Atropurpureus , a native plant of the United States. It 
contains an active principle, Euohymin, B. P. As a laxative its action 



250 DRUGS. 

is very slow and mild; it is thought to act particularly on the liver, 
and may be used when moderate hepatic torpor is present. 

Administration. — The dose of the solid extract (Extractum Euonymi, 
U. S., Extractum Euonymi Siccum) is 3 to 10 grains (0.20-0.60). Of 
euonymin the dose is \ to 1 grain (0.03-0.06). 

EUPATORIUM. 

Eupatorium, U. S., Thoroughwort or Boneset, is the leaves of Eupa- 
torium perfoliatum, an American plant which is largely used as a 
simple bitter tonic and diaphoretic in household medicine. The drug 
is generally given in hot infusion in cases of arrested menstruation 
due to cold or in the chill of a remittent or intermittent fever, and also 
for anorexia and debility. Its taste is very disagreeable. In the dose 
of a pint (480 c.c.) of the cold infusion it has been used as an emetic. 
The fluid extract (Extractum Eupatorii Fluidum, U. S.) is given in 
the dose of 30 minims to 1 drachm (2.0-4.0). 



EUPHORBIA PILULIFERA. 

This herb is sometimes called Snake-weed or Cat's Hair, and is a 
native of Australia and the West Indies, where, like stramonium, it 
grows profusely as a weed by the roadside. 

Physiological Action. — In toxic doses the drug kills small animals 
by failure of the respiration and circulation, these two vital functions 
being greatly affected by doses which exert no great influence on the 
rest of the body. In full dose it may cause some gastric irritation. 

Therapeutics. — Euphorbia pilulifera is one of the latest remedies 
introduced into medicine for the relief and cure of asthma, in which 
disease the results obtained, after other remedies fail, are very extraor- 
dinary if the reports of those who have given it a thorough trial can 
be accepted without reserve. As yet we do not know the form of asthma 
which is most relieved by its use, and its employment is purely empir- 
ical. It has also been highly praised in the treatment of chronic bron- 
chitis and emphysema. 

Administration. — Euphorbia pilulifera is best given in the form of 
the fluid extract in the dose of 30 minims to 1 drachm (2.0-4.0). The 
decoction is made by adding a " handful of stalks with the leaves on 
them to 2 quarts (2 litres) of boiling water, and boiling down to 1J 
quarts (H litres)." Of this decoction the dose is a small wineglass- 
ful (60.0) three times a day. (See Asthma.) 



EUPHTHALMIN. 

Euphthalmin is a synthetic alkaloid used as an active mydriatic. 
It possesses an effect upon the general system very like that of atro- 



EXALG1NE. 251 

pine, but when first dropped into the eye may cause slight salivation 
through irritation of the secretory fibres of the chorda tympani, which 
it reaches after absorption. The pupil under its influence begins to 
dilate in from fifteen to twenty minutes after a few drops of a 2 to 10 
per cent, solution are instilled. The maximum dilatation is reached 
in about an hour, and disappears in about five to eight hours. Vinci 
states that the mydriasis is due to paralysis of the oculomotor nerve- 
endings, and that the sympathetic is not affected. 



EUROPHEN. 

Europhen is the result of the action of iodine on isobutylortho- 
cresol, in the presence of an alkali, and appears as a fine yellow powder, 
soluble in alcohol, ether, chloroform, and oils, but insoluble in water. 
It was introduced because it was hoped that it might prove a useful 
substitute for iodoform. One advantage claimed for it is that it 
parts with its iodine very slowly, and so is not apt to produce toxic 
symptoms as rapidly as does iodoform. For this reason, however, 
it lacks the remedial power of the older drug, except in those instances 
in which a drying power is needed which will keep the wound pure 
by making it too dry to be favorable to the growth of germs. When 
such an action is desired, europhen possesses the additional advantage 
of being five times as bulky as iodoform. In the treatment of 
tuberculous growths europhen has proved itself very inferior to 
iodoform. Owing to its stability, it fails to part with its iodine except 
in the presence of moisture, and is useless in dry skin diseases. It 
has been found useful in scrofuloderma, ulcer of the legs, and lupus. 
Europhen may be employed externally in a salve of the strength of 
from 5 to 10 per cent., or with olive oil or lanolin. It can also be added 
to flexile collodion. The drug does not possess the odor of iodoform, 
but experience will probably prove it to be more irritating than the 
latter drug. The internal dose is 1 to 3 grains (0.06-0.20) in cases 
of syphilis. Europhen is incompatible with metallic oxides and the 
preparations of mercury, and also with the starch and zinc paste 
largely used by dermatologists. 



EXALGINE. 

This substance is really methyl-acetanilid, and closely resembles 
acetanilid or antifebrin in its effects. It is given for the same purposes 
as are acetanilid and antipyrin — namely, for the relief of pain in loco- 
motor ataxia and other nervous affections — but never as an antipyretic. 
When used, exalgine should be given night and morning as a rule, so 
that the doses shall not be near together. The beginning dose should 
be from 2 to 4 grains (0.12-0.25), and not more than 15 grains (1.0) 



252 DRUGS. 

should be given in twenty-four hours. It is stated by those who have 
used the drug that fever contraindicates its employment. 
The following prescriptions will be found applicable: 

1^— Exalgini gr . xxx (2.0). 

Tincturae aurant. dulcis f3ij (8.0). — M. 

Ft. in sol. et adde 

Syr. aurantii fgss (16.0). 

Aqua? menth. piperit. . . . q. s. ad f giv (120.0).— M. 
S. — A tablespoonful night and morning. 

Or, 

Ifc— Exalgim • gr. xxx (2.0). 

Spt. frumenti fgss (16.0).— M. 

Ft. in sol. et adde 

Syr. simplicis f§j (30.0). 

Aquas dest q. s. ad f §iv (120.0).— M. 

S. — Tablespoonful night and morning. 

FLAXSEED. 

Flaxseed or Linseed (Linum, U. S. and B. P.) is the seed of Linum 
usitatissimum, or flax from which linen is made; it is official in the 
B. P. as Lini Semina. These seeds contain an oil and a mucilage, 
the first of which is largely used in the arts, and the second is some- 
times employed in medicine. The oil (Oleum Lini, U. S. and B. P.) 
is also used by physicians and pharmacists for various purposes. 

Therapeutics. — Flaxseed acts as a demulcent to inflamed mucous 
membranes, and is used largely in the treatment of acute cystitis, 
bronchitis, gastritis, nephritis, and similar states, in the form of flax- 
seed tea. This is prepared by mixing together 3 drachms (12.0) of 
flaxseed, not ground, 30 grains (2.0) of extract of liquorice, 10 ounces 
(300.0) of boiling water, and allowing the mixture to stand one to 
four hours in a warm place. If the mixture is boiled, the oil is set 
free and makes the dose disagreeable. This infusion may now be 
made more tasteful and useful by the addition of a little lemon-juice 
and sugar and by the placing of from 1 to 2 drachms (4.0-8.0) of gum 
arabic in the pitcher containing it. If the cough is excessive, a little 
paregoric may be added. Linseed oil is used sometimes as a laxative 
in the dose of 2 ounces (60.0), and is said to be of service when so 
given in the treatment of hemorrhoids. 

Flaxseed meal (Lini Farina) when moistened is employed uni- 
versally as a useful poultice. 

Under the name of Carron oil (Linimentum Calcis, U. S.) an 
emulsion of lime-water and linseed oil, equal parts, is the standard 
application for limited or extensive burns, 

FORMIC ALDEHYDE (FORMALDEHYDE). 

Formic aldehyde is a gaseous body difficult of application because 
of its physical characteristics, but nevertheless possessing very great 



FORMIC ALDEHYDE {FORMALDEHYDE). 253 

power as a disinfectant or germicide. It is prepared by subjecting 
methyl alcohol to oxidation, and almost every instrument-maker has a 
device whereby this gas may be generated, and the room formerly occu- 
pied by a sick person thereby disinfected far more efficaciously than can 
be accomplished by burning sulphur. The doors and windows of the 
room should be tightly shut during the process of disinfection and for 
several hours after the formaldehyde generator is exhausted. As the 
gas is exceedingly irritating to the eyes and respiratory passages, no one 
should attempt to enter the room. After the disinfection is completed 
the room should be aired for some hours, or, if it must be used at once, 
it may be rendered capable of habitation by spraying a 20 per cent, 
solution of ammonia to neutralize the acid atmosphere. The great 
advantage of formaldehyde for these purposes is the fact that it per- 
meates every nook and cranny, and yet does no injury to colored 
fabrics, as does chlorine gas under similar circumstances. Such 
generators as have been named can be had for about four dollars. 

Liquor Formaldehydi, U. S. is an aqueous solution of formaldehyde 
which contains 37 per cent, by weight of the gas. It forms a clear, 
colorless liquid of a pungent odor, which is particularly irritating to 
mucous membranes. It can be mixed with water and alcohol in all 
proportions, but on standing its solution becomes milky because of 
the separation of paraformaldehyde. It should be kept in a cool 
place protected from light. 

The official solution of formic aldehyde, in the strength of 37 per 
cent., has been widely used of late for disinfectant and antiseptic pur- 
poses. For all these purposes it is usually diluted still further by the 
addition of water. A 1 per cent, solution is usually quite active enough 
for surgical antisepsis, and is far less poisonous than is the bichloride 
of mercury. A similar percentage, or a little stronger, may be used 
to preserve pathological specimens, and it is stated that in the propor- 
tion of 1 to 32,000 it will preserve milk for several days. Taken inter- 
nally in small amounts, it does not possess any toxic properties. 

Concentrated undiluted formaldehyde solution may be used for the 
purpose of cauterizing syphilitic sores. 

The safety, efficiency, and cheapness of formaldehyde gas as a dis- 
infectant, and of the solution, render this agent a most valuable one. 
(See Disinfection.) 

Formaldehyde is useful to check excessive fetid sweating by virtue 
of its antiseptic effect and because it hardens and contracts the skin. 
The solution used may be made by diluting the 37 per cent, com- 
mercial solution with 4 to 6 parts of water, or using Euformol diluted 
or pure as a lotion. Euformol contains eucalyptus, gaultheria, menthol, 
boric acid, and formaldehyde, and is pleasanter to use than the crude 
preparation. Diluted in the proportion of 1 to 4 of water, it may be 
employed as a lotion to the entire body to check colliquative sweats. 

Under the name of "Glutol" a compound of formaldehyde and 
gelatin is used as an antiseptic powder, which, drying the surface of 



254 DRUGS. 

the wound or ulcer, seals it and renders it sterile. It is claimed to be 
a particularly efficient dressing for bums. 



GALLIC ACID. 

Acidum Gallicum (U. S. and B. P.) is usually prepared from tannic 
acid. It occurs in nearly colorless, long, needle-like crystals, which 
are soluble in 100 parts of cold water, 4J parts of alcohol, and 3 parts 
of boiling water. 

Physiological Action. — Gallic acid is an astringent, but not a coag- 
ulator of blood. Locally applied in bleeding, it is useless, but given 
internally in hemorrhages which cannot be acted upon by the direct 
local application of tannic acid, it is thought to be useful as a haemo- 
static because it contracts the bloodvessels. It is eliminated from the 
body by the kidneys as gallic acid. 

Therapeutics. — Gallic acid may be used with some success in hcema- 
turia, hcemoptysis, colliquative sweats, and in chronic bronchitis with 
profuse expectoration. 

Combined with opium, it is one of the best remedies in diabetes 
insipidus, and is also useful in diabetes mellitus. 

In albuminuria dependent upon a relaxed, atonic state of the kidneys 
and in acute or chronic diarrhea gallic acid may be used with advan- 
tage. In the form of the ointment it is useful in the treatment of 
psoriasis, and in the cure of ulcers and sores which are actively dis- 
charging. A very useful application to external hemorrhoids is equal 
parts of stramonium ointment and gallic acid. 

Administration. — Gallic acid is given in the dose of 2 to 40 grains 
(0.12-2.6) in pill or solution. It ought never to be used with any salt 
of iron, as it is chemically incompatible. The preparation used locally 
is Unguentum Acidi Gallici. 



Nut-gall. 

Nut-galls (Galla, U. S. and B. P.) are the small excrescences found 
upon the oak (Quercus lustianica) formed by the ova of the fly Cynips 
Gallon tinctorial. Their sole value depends upon the tannic acid con- 
tained in them, and they are official in the form of the tincture (Tinc- 
tura Galla?, U. S.), dose h to 2 fluidrachms (2.0-8.0), and the ointment 
(Unguentum Galla?, U. S. and B. P.). Unguentum Galla? cum Opio 
is official in the B. P., and is used as an astringent and sedative oint- 
ment. 



GAMBTR. 255 



GAMBIR. 



Gambir is an extract derived from the leaves and young shoots of 
Ouronparia Gambier. It takes the place held by catechu. Gambir 
depends for its medicinal value upon the astringent properties which 
it possesses. Beyond this power it has no particular value. 

It is of a dark-red color, has a somewhat sweetish taste, and is insol- 
uble, like most extracts, in water. 

Therapeutics. — Like all the vegetable astringents, gambir is used as 
a remedy for diarrhoea, particularly that of the serous type or that in 
which the stools are of too fluid a consistence. If large amounts of 
mucus in the passages show a catarrhal state of the bowel, the mucus 
should be displaced by a purge of castor oil or sulphate of magnesium 
before the astringent is used. 

Gambir may or may not be combined with opium in cases of diar- 
rhoea, but the following prescription will be found of service in many 
instances : 

For an adult : 

Ji — Tinct. gambir composit f^ij (60.0). 

Tinct. opii camphoratae ^2^ (60.0). 

Misturae cretse fgij (60.0).— M. 

S. — Dessertspoonful (8.0) every four hours till relieved. To be shaken before 
using. 

In cases of sore throat where the secretion is excessive and the inflam- 
mation subacute, gambir may be used as a gargle. 

In cases of spongy gums gambir is sometimes useful as a mouth- 
wash. If the powdered gambir is used internally, the dose is 20 to 
30 grains (1.3-2.0). The dose of the Compound Tincture of Gambir 
(Tinctura Gambir Composita, U. S.) is 1 to 2 fluidrachms (4.0-8.0). 
Its only constituent besides the gambir is cinnamon. The Troches of 
Gambir (Trochisci Gambir, U. S.) are to be employed in sore throat, 
and are to be held in the mouth. They are not generally used. 

In the B. P. gambir is still official as catechu and the following 
preparations are also official: Trochisci Catechu; the tincture (Tinc- 
tura Catechu), dose 1 to 2 fluidrachms (4.0-8.0); and a compound 
powder (Pulvis Catechu Compositus), composed of catechu, kino, and 
rhatany, the dose of which is 20 to 4 grains (1.3-02.6). 



GAULTHERIA. 

Wintergreen, or Gaultheria procumbens, is an x\merican evergreen 
containing a volatile oil. The oil possesses a peculiar, exceedingly 
penetrating odor and a warm aromatic taste. It is about 96 per cent, 
salicylate of methyl. Salicylate of Methyl (Methyl Salicylas, U. S.) 
is an artificial product made official in the last revision of the tl S^ P„ 



256 DRUGS. 

Physiological Action. — Owing to the large amount of salicylate of 
methyl contained in the oil, its physiological action is almost identical 
with that of salicylic acid. 

Therapeutics. — Aside from its use as a flavoring substance, oil of 
gaultheria may be used in place of the ordinary salicylates in all forms 
of rheumatism in which they are useful. This oil (Oleum Gaultheria?, 
U. S.) is best given in capsules or emulsion or dropped on a teaspoonful 
of sugar three times a day after meals. The dose may be as high as 
100 minims (6.6) a day, but if 60 minims (4.0) three times a day are 
without effect, pushing it further is useless. Very few patients can 
take more than 30 minims a day without suffering from a disordered 
stomach. 

Lannois and Limousin have highly recommended the application 
of this oil to acute and chronic rheumatic joints. The oil is placed 
on lint, and then the lint is wrapped around the part affected, 
evaporation being prevented by applying a gutta-percha covering. 
They assert that this treatment gives rapid relief, although they admit 
that after it the skin may desquamate. 

The spirit of gaultheria (Spiritus Gaultheria?, U. S.) is given in the 
dose of 10 to 20 minims (0.60-1.3). 



GELSEMIUM. 

Gelsemium, U. S., and Gelsemii Radix, B. P., or Yellow Jasmine, 
as used in medicine is the rhizome of Gelsemium sempervirens, & 
climbing plant of the Southern United States. It contains an alkaloid, 
gelsemine, and gelseminic acid. 

Physiological Action. — Nervous System. — Gelsemium paralyzes 
the spinal cord, particularly on its sensory side (?), although the motor 
side is certainly ultimately depressed. It does not influence the nerves 
or muscles except those of the head, on which it acts as a paralyzant, 
particularly affecting the motor fibres. 

Circulation. — Gelsemium is a depressant to the circulation, act- 
ing particularly on the heart. It paralyzes the vagus and lowers blood- 
pressure. 

Respiration. — Gelsemium kills by paralyzing the respiratory cen- 
tres (Sanderson, Ringer, and Murrell). 

Temperature. — In overdose the drug lowers bodily heat very 
markedly. 

Eye. — Gelsemium is a mydriatic of considerable power, causing, 
when dropped into the eye, wide dilatation of the pupil, a result due 
to paralysis of the oculomotor nerve peripherally. 

Therapeutics. — Gelsemium is used in headache and migraine depend- 
ing on nervous troubles or upon eye-strain. It is particularly useful 
in combination with cannabis indica. (See Cannabis Indica and 
Migraine.) 






GENTIAN. 257 

In malarial fever it is said to be of service, but this is doubt- 
ful. In the early stages of pneumonia and pleurisy it has been highly 
spoken of by Bartholow. 

Gelsemium has also been found of value in asthma, whooping cough, 
laryngismus stridulus, and nervous cough. In localized muscular 
spasm, such as is seen in torticollis or wryneck, and in spasmodic 
dysmenorrhea, it is of considerable service. It ought not to be 
used if the system is already depressed, but only in sthenic cases. 

When used as a mydriatic, Tweedy recommends gelsemine as equal 
to atropine in effect, but much more transient in its influence. He uses 
a solution of 8 grains of gelsemine to the ounce (0.5-30.0) of water 
instilled, drop by drop, into the eye every fifteen minutes for one hour, 
and then every half -hour for two hours. 

Poisoning. — The most prominent symptoms of gelsemium poison- 
ing are ptosis and dropping of the jaw. These are preceded by a 
sensation of languor, a desire to lie down, relaxation, and muscular 
weakness. Gelsemium is apt to cause temporary internal squint, 
owing to its paralyzant action on the sixth pair of cranial nerves. 
The pulse becomes rapid and feeble, the skin wet and cold, the face 
pinched and anxious, the voice is lost, and death ensues from centric 
respiratory failure and an almost simultaneous cardiac arrest. Sen- 
sation in man is impaired very late in the poisoning. 

The treatment of the poisoning consists in the use of cardiac stimu- 
lants, such as ammonia and digitalis, the application of external heat, 
and the employment of atropine and strychnine for the purpose of 
stimulating the respiratory centre. Emetics and the stomach-pump 
are, of course, to be employed if the patient is strong enough. 

Administration. — The fluid extract (Fluidextractum Gelsemii, U. S.) 
is given in the dose of 2 to 5 minims (0.10-0.30), and the tincture 
(Tinctura Gelsemii, U. S. and B. P.) 5 to 15 minims (0.30-1.0). In 
some parts of the United States physicians largely employ a very strong 
unofficial tincture of gelsemium, the dose of which is 1 to 2 minims. 
Gelsemine may be used in the dose of -fo grain (0.001). 



GENTIAN. 

Gentiana, U. S., is the root of Gentiana lutea, or Yellow Gentian, 
a European plant. It contains gentianine and gentisic acid, and has 
a bitter taste. This drug is official in the B. P. as Gentiana? Radix. 

Therapeutics. — Gentian is one of the most efficacious bitter tonics 
that we possess. In the anorexia following acute diseases and in gout 
and malarial poisoning with dyspepsia it is of value. Combined with 
bicarbonate of sodium, it is of great service in the treatment of the 
subacute gastric and intestinal catarrh of children. 

Administration. — The compound tincture (Tinctura Gentians Com- 
posita, U. S. and B. P.) is given in the dose of 1 to 2 drachms (4.0- 

17 



258 DRUGS. 

8.0), the fluid extract (Fluidextr actum Gentianoe, U. S.) in the dose 
of 30 minims to 1 drachm (2.0-4.0), and the solid extract (Ex- 
traction Gentianoe, U. S. and B. P.) in the dose of 1 to 8 grains (0.06- 
0.50). Injusum Gentians Composition, B. P., is given in the dose of 
1 to 2 fluidounces (30.0-60.0). The compound tincture and com- 
pound infusion are composed of gentian, bitter orange-peel, and car- 
damoms. The following prescription is an excellent one for use in 
convalescence from prolonged fevers: 

1^— Acid, nitro-hydrochlor. dil. . . . f 5j vel f 5 ij (4.0-8.0). 

Tr. nucis vomicae f3j (4.0). 

Tr. cardamomi comp f^ij (60.0). 

Tr. gentianse comp. . . q. s. ad fgiv (120.0). — M. 
S. — Teaspoonful (4.0) in water after meals. 



GERANIUM. 

Geranium, U. S., is the rhizome of Geranium maculatum. It con- 
tains tannic and gallic acids, and is useful as an astringent in cases of 
serous diarrhoea. It is not the common red geranium seen in flower- 
gardens. 

In infantile diarrhea geranium-root, boiled in milk in the propor- 
tion of one or two roots to the pint, will be found of great service and 
is tasteless. The dose of the drug itself is 20 to 60 grains (1.3-4.0), 
and that of the fluid extract {Fluidextr actum Geranii, U. S.) \ to 1 
fluidrachm (2.0-4.0.) 

GINGER. 

Zingiber, U. S. and B. P., is the rhizome of Zingiber officinale, sl 
plant of Hindostan, Jamaica, and other tropical countries. Black 
ginger is the dried rhizome with its bark, while white ginger has this 
covering removed. It contains a hot volatile oil and an aromatic 
resin, and is largely used in domestic medicine as a carminative 
and stomachic. In the treatment of menstrual cramps it is often given, 
and is particularly useful in those cramps due to suppression from 
exposure to cold. Ginger is often combined with purgative medicine 
to stop griping and for its pleasant flavor. Of itself it is decidedly 
constipating, and when used in diarrhoea mixtures is of value other 
than as a flavoring addition to the prescription. 

Administration. — The fluid extract {Fluidextr actum Zingiberis, U. S.) 
is given in the dose of 10 to 30 minims (0.60-2.0), well diluted; the 
tincture (Tinctura Zingiberis, U. S. and B. P.), dose 20 minims to 
2 drachms (1.3-8.0); the syrup (Syrupus Zingiberis, U. S. and B. P.), 
dose 30 minims to 2 drachms (2.0-8.0); the oleoresin (Oleoresina 
Zingiberis, U. S.), dose h to 1 minim (0.03-0.05), well diluted or in 
pill; and the troches (Trochisci Zingiberis) used as stimulants to 
salivary secretion. 






GLANDULAR EXTRACTS. 259 



GLANDULAR EXTRACTS. 



Within the past two decades physiological investigations have 
proved that several glands in the body not only secrete substances in 
the body-cavities, but also pour out into the blood- or lymph-vessels 
ferments or substances which perform definite physiological functions 
in the system. Disease of these glands perverts these functions, and 
secondary disorders follow. Acting upon the discoveries just named, 
some persons have attempted to show that nearly all of the organs of 
the body, be they glands or not, possess these functions, until they 
have reached a reductio ad absurdum. On the other hand, some of 
the glands are now used, when derived from the lower animals, for 
definite therapeutic purposes, such as the thyroid gland and the supra- 
renal bodies, for example. The use of the glands will be found dis- 
cussed under their own names, but unimportant glands in therapy, or 
those in regard to which doubt exists, are included under the general 
heading here given. 

The employment of testicular juice, or the dried gland itself, has 
been practically abandoned, but the extract of the ovary seems to possess 
considerable power. It has been used to combat the symptoms follow- 
ing double oophorectomy and those common to the menopause, and 
also for aphrodisiac purposes. On the ground that chlorosis is due to a 
faulty internal secretion of the ovary, it has been given in this condi- 
tion with asserted good results, and also in osteomalacia, neurasthenia, 
and hysteria in females. The dose is from 2 to 4 grains (0.10-0.20) a 
day. (See Ovarian Extract and Mammary Gland.) 

The use of cerebral and spinal extracts has proved futile, as has 
also the use of bone-marrow, in pernicious anamiia. The pancreas 
has been used in pancreatic diabetes, but its value is in doubt. The 
liver has been given in the dose of 3 ounces (90.0) of fresh gland a 
day to combat the delirium of cirrhosis, with asserted good results 
(Carnot), and has been thought to do good in alcoholic cirrhosis with 
icterus, in that the hemorrhages were arrested, the delirium ceased, 
and the patient generally improved. The same treatment has been 
tried in diabetes. It is difficult to see how it can be of benefit. 

While glandular therapeutics gives promise of aiding greatly in 
the treatment of disease, and while for this reason the cautious phy- 
sician should not oppose resort to the use of glandular extracts, he 
should, nevertheless, always study the physiological function of the 
gland to be employed in order that he may reach a clear idea of its 
remedial possibilities. The extraordinary effects of some glands do 
not prove that all animal extracts are of value, nor does the failure of 
others indicate that all are useless. 



260 DRUGS. 



GLYCERIN. 



Glycerinum, U. S. and B. P., is a liquid obtained by the decom- 
position and distillation of fats. It possesses great power in absorbing 
water and of dissolving many substances. Even if pure it irritates the 
skin of susceptible persons when applied locally, by its absorption of 
water, and often causes a slight rash. 

Physiological Action. — Injected into the circulation in large amounts, 
glycerin causes convulsions, which are due to its hygroscopic power. 

According to the clinical researches of Pavy, glycerin increases the 
polyuria of diabetes almost one-half, and for this reason he thinks it is 
not to be employed in this class of cases as a substitute for sugar. Other 
clinicians, however, disagree with him and use it constantly for this 
purpose with asserted advantage. 

Therapeutics. — Glycerin may be employed as a sweetening agent 
in the food of diabetics and in cases where sugar cannot be used. It 
has also been given as a laxative in 1- or 2-drachm (4.0-8.0) doses by 
the mouth, and in enema — 1 to 4 drachms (4.0-16.0) with or without 
equal parts of water. In some cases it may be used in suppository in 
the official Suppositoria Glycerini, U. S. and B. P. This latter method 
is very successful in chronic constipation. Its continued use by sup- 
pository may, however, result in rectal irritation. 

As an antiseptic it is used for preserving specimens and for keeping 
alkaloids in solution for hypodermic use. 

In acute coryza, applied by a spray or brush to the nostrils, it is 
sometimes of service; for this purpose it should be diluted four or five 
times with water. If used on the skin, it should be diluted one-half 
with water. In cases of impacted cerumen in the external auditory 
canal glycerin is often of service in softening the mass. 

The uses of glycerin, other than those mentioned, are many. In the 
proportion of equal parts of glycerin and water it makes a very useful 
mouth-wash for the sore and dry mouth of typhoid fever and for the 
removal of sordes. The same wash, with lemon-juice added to it, is 
very agreeable and will relieve the dry, glazed tongue of advanced 
phthisis. 

Owing to the fact that glycerin is hygroscopic, it may be used as a 
depletant on a pledget of cotton in congestion of the uterine cervix, the 
tampon being renewed daily. (See Boric Acid and Boroglyceride.) 

For the prevention of bed-sores Ringer recommends the daily wash- 
ing and rubbing of the part likely to be affected, followed by the appli- 
cation of glycerin and water, with a draw-sheet placed smoothly 
against the patient to protect the bedding. 

Glycerin and whiskey is a favorite household remedy for colds and 
coughs, but is not very useful. Glycerite of starch {Glyceritum Amyli, 
U. S. ; Glycerinum Amyli, B. P.) is used as a protective over super- 
ficial irritations of the skin. Glycerite of yolk of egg {Glyceritum 
I ^itelli) is used in making emulsions. 



GR1NDELIA ROBUSTA. 261 

A very useful ointment for the application of medicinal substances 
to the skin may be made by constantly mixing in the presence of heat 
1 part of potato starch and 15 parts of pure glycerin. The result is a 
clear, transparent, jelly-like substance which does not decompose, and 
has the advantage of holding the medicament which it carries in solu- 
tion rather than by mechanical suspension. 

The B. P. preparations of glycerin are as follows: Glycerinum 
Acidi Carbolici, Glycerinum Acidi Tannici, Glycerinum Aluminis, 
Glycerinum Acidi Borici, Glycerinum Plumbi Subacetatis, Glycerinum 
Tragacanthce, Glycerinum Boracis, Glycerinum Pepsini, Glycerinum 
Amyli, and Unguentum Glycerini Plumbi Subacetatis. 



GOLD. 

Gold itself is not official in the U. S. P., but has been recom- 
mended very highly by Bartholow in chronic Brighfs disease in the 
form of the chloride of gold and sodium (Auri et Sodii Chloridum, 
U. S.). The dose of this substance is ^ to ^ grain (O.C03-0.006) 
once, twice, or thrice a day. The author has not found it of much 
value. Gold has also been strongly recommended for indigestion with 
epigastric pain after eating when looseness of the bowels is present, 
and it is said to act as a powerful sexual stimulant and to be of service 
in impotence dependent upon inability to obtain an erection or when 
there is deficient glandular action. It has also been used in excessive 
nocturnal emissions in masturbators, with asserted great success. In 
overdoses the drug causes gastro-enteritis. Magruder has recommended 
chloride of gold and sodium in the treatment of pertussis. 



GRINDELIA ROBUSTA. 

Grindelia, U. S., is an American plant (Grindelia robusta) containing 
a resin, a volatile oil, and an alkaloid. 

Physiological Action. — Upon the lower animals and man this drug 
is not very powerful in its action, but may cause, in large doses, par- 
alysis of the peripheral sensory nerves, the sensory centres in the spiral 
cord, and finally the motor centres and nerve-trunks. It slows the 
heart by stimulating the vagi, and raises blood-pressure by stimulating 
the vasomotor centre. 

Therapeutics. — Grindelia robusta is an exceedingly useful remedy 
in some cases of asthma and in bronchitis in its later stages. It may be 
given in the dose of 20 to 60 minims (1.3-4.0) of the fluid extract 
(Fluidextractum Grindelia?, U. S.), or by inhaling the fumes of 
burning grindelia-leaves, which have been previously soaked in a solu- 
tion of nitre, dried, and burned on a plate or rolled into a cigarette 
and smoked. In chronic cystitis it stimulates the bladder and is 
of service. By diluting it 1 to 10 with water it forms one of the best 



262 DRUGS. 

lotions that we have for the relief of the dermatitis produced by poison 
ivy or Rhus Toxicodendron. 

Administration. — The only preparation which is official is the fluid 
extract (Fluidextractum Grindeliee, U. S.), dose 20 to 60 minims 
(1.3-4.0). 

GUAIAO. 

Lignum Vitse, or Guaiacum officinale, a West Indian tree, is used 
in medicine as guaiac resin {Guaiacum, U. S. ; Guaiaci Resina, B. P.), 
or guaiac, which is soluble in alcohol, ether, and chloroform, but is 
insoluble in water. 

Therapeutics. — Guaiac has been largely used in syphilis, but is now 
rarely, if ever, so employed. Given in acute tonsillitis in the dose of 30 
grains in an emulsion made by the use of white of egg, it will often 
abort an attack. In rheumatism it has been largely used. In the 
treatment of gout, Luff has highly commended it as a preventive, given 
in cachet or capsule in the dose of 5 grains (0.3) of the powdered 
resin three times a day and gradually increased to 10 grains (0.60) at 
a dose. The ammoniated tincture of guaiac is sometimes employed 
in the treatment of sore throat, particularly if it be rheumatic in type, 
but is a disagreeable preparation to take into the mouth, and the sali- 
cylates may always be used in its place. 

Administration. — The tincture (Tinctura Guaiaci, U. S.) is given in 
the dose of 5 to 60 minims (0.30-4.0), and the ammoniated tincture 
(Tinctura Guaiaci Ammoniata, U. S. and B. P.) is used in the same 
dose, preferably in milk. Mistura Guaiaci, B. P., is given in the dose 
of 1 to 2 fluidounces (30.0-60.0). Trochiscus Guaiaci Resina are 
official in the B. P. 



6UAIAC0L. 

Guaiacol (U. S.) is a liquid constituting from 60 to 90 per cent, of creo- 
sote. It is obtained by the distillation of beechwood creosote, followed 
by a complicated process which it is not necessary to describe. In other 
cases guaiacol is obtained from beechwood creosote by precipitation 
with barium hydrate. In still other instances a very pure crystalline 
solid guaiacol is made synthetically from pyrocatechin. Much of 
the "absolute guaiacol" of commerce is impure. Chemically pure 
guaiacol, obtained by the process last named, is a light-colored solid 
of an agreeable odor and soluble in water in the proportion of 1 to 85 
Helbing). It is readily soluble in alcohol and ether. As it melts at 
83.5° F., it usually is dispensed in a fluid form. 

Therapeutics. — Guaiacol has been largely used by some practition- 
ers, chiefly in Europe, in the treatment of tuberculosis as a substitute 
for creosote, because it is the principal ingredient of that drug. (See 



GUAIACOL. 263 

Creosote.) It was thought by Guttmann, Sommerbrodt, and others 
that the good effect of creosote was due to its destructive action on the 
bacillus, or that it so improved digestion as to increase the resistance of 
the patient to the spread of the disease. Recently Hoelscher and 
Seifert have asserted that guaiacol and creosote produce their good 
effects by forming compounds with the toxins or poisonous albumin- 
oids formed by the bacilli, which are then eliminated from the body. 
There is no proof of this. The same rules govern the use of guaiacol 
as govern the employment of creosote. It is best given with brandy, 
wine, or other alcoholic drink, or in capsule with cod-liver or sweet oil. 
5 or 10 minims (0.30-0.60) of guaiacol may be added to a pitcher 
of hot water and the vapor inhaled three or four times a day in 
cases of subacute and chronic bronchitis. The dose by the stomach 
is 5 to 20 minims (0.30-1.3). In acute follicular tonsillitis pure guaiacol 
may be painted over the tonsils with advantage. Indeed, it is the best 
application for this purpose. 

Clinical observations prove conclusively that guaiacol possesses 
powerful antipyretic influences. As pointed out by Sciolla in 1893, 
guaiacol when painted on the skin of a febrile patient causes a pro- 
nounced fall of temperature, which begins soon after the application is 
made, but is not fully accomplished for from two to three hours. The 
application may be made to the skin of the abdomen, thighs, or chest, 
about 30 to 40 minims (2.0-2.6) being used with a brush. When a 
full effect is required, it is well to place an impermeable dressing over 
the part painted to prevent evaporation and aid absorption. These 
applications may be resorted to as often as is necessary for the reduc- 
tion of the fever, and, although the fall of temperature is sometimes very 
rapid and very great — as much as 7 degrees F. in two hours — Da Costa 
has never seen serious nervous or cardiac symptoms produced, but 
other observers have noted such untoward results. The temperature 
is very apt to rise speedily after the reduction, and this rise is often 
preceded by a chill. These applications cannot supplant the cold bath, 
although they undoubtedly do reduce the temperature. The true 
sphere of usefulness to be assigned to guaiacol as an antipyretic seems 
to be that of a less valuable therapeutic measure than the bath, and 
one equally powerful and about as dangerous as are the antipyretic 
drugs of coal-tar derivation. 

The studies of Stolzenberg show that if frequently and constantly 
used guaiacol produces in febrile patients a tendency toward depression. 
Thayer finds that great sweating and depression generally follow its 
external use in fevers. Future reports will probably develop the fact 
that in cases of renal irritation guaiacol will prove harmful. 

Guaiacol has been used by painting it on the affected part in the 
treatment of superficial neuralgias, and in deep-seated nerve-pains, as 
in sciatica, it has been given hypodermically, in the dose of 2 minims 
in 10 minims of spirit of chloroform, injected deeply into the neighbor- 
hood of the painful nerve. 



264 • DRUGS. 

If guaiacol is placed upon the skin by means of a small compress, 
which has been wet with it and bound tightly to the part, local anaes- 
thesia is rapidly developed; but if left in place too long, it may be 
absorbed in sufficient amount to cause depression or a fall of tempera- 
ture. 

Belfield highly recommends painting the scrotum with guaiacol 15 
minims (1.0) and glycerin 45 minims (3.0) for orchitis, or an ointment 
of guaiacol 1 drachm (4.0) to 4 drachms (16.0) of lanolin may be 
rubbed into the scrotum and applied on lint. This should be applied 
every other day. 

A serious objection to the external use of guaiacol is its disagreeable 
odor. 

GUAIACOL CARBONATE. 

Carbonate of guaiacol {Guaiacol Carbonas, U. S.) is a white, crystal- 
line powder, consisting of 91.5 per cent, of pure guaiacol and 8.5 per 
cent, of carbonic acid. This powder is insoluble in water, soluble in 
48 parts of alcohol and 1.5 parts of chloroform, neutral in reaction, 
and is said to be without irritating effect on the stomach. Taken by 
the healthy individual, it is decomposed into guaiacol and carbonic 
acid in the bowel, but not in the stomach, and it is used for this 
reason, as salol is, as an intestinal antiseptic, in the various forms of 
fsrmentative diarrhoea and typhoid fever. The drug is said to be 
slowly absorbed, but after absorption is rapidly eliminated. Its 
therapeutic applications in tuberculosis are practically identical with 
those of pure guaiacol, save that it is more readily borne by the 
stomach than the latter drug. Guaiacol carbonate may be given in 
capsule or pill, or it may be given in dry powder on the tongue in the 
dose of 2 to 10 grains (0.12-0.60). Usually in typhoid fever the dose 
is about 2 grains (0.12) every three hours, and in tuberculosis of the 
lungs 5 grains (0.30) three times a day. 

H^MATOXYLON. 

Hcematoxylon, U. S., Hoematoxyli Lignum, B. P., or Logwood, is 
the heart-wood of Hcematoxylon campechianum, a tree of the American 
tropics. It contains an active principle, hsematoxylin. 

Therapeutics. — Hcematoxylon is a mild astringent, very useful in 
serous diarrhoeas and the diarrhoeas of young children, as children do 
not dislike it, owing to its agreeable taste. (See article on Diarrhoea.) 
As it colors the stools and urine red, the nurse should be warned lest 
she be alarmed at the sight of what looks like blood on the diaper after 
the drug is given to infants. If the urine is alkaline, the color may be 
violet or red. In leucorrhoea its internal use is of service. The extract 
(Extr actum Hoematoxyli, U. S.) is given in the dose of 8 to 30 grains 
(0.5-2.0), and Decoctum Hoematoxyli, B. P., in the dose of 1 to 2 fluid- 



HEROIN. 265 

ounces (30.0-60.0) . An unofficial fluid extract is often to be found in 
the shops. The dose of this is £ to 2 fluidrachms (2.0-8.0\ (See 
article on Diarrhoea.) 



HAMAMELIS. 

Hamamelidis Cortex and Hamamelidis Folia, U. S. and B. P., 
Witch-hazel, or Hamamelis virginiana, is a plant of the United 
States, devoid of any active principle, but possessing extraordinary 
remedial power. 

Therapeutics. — Hamamelis is to be employed in relaxed sore throat 
resulting in congestion and hyperemia upon exposure or where mild 
catarrhal states are present. Similarly, it is employed in an atomizer, 
after attacks of acute coryza, to tone up the nasal mucous membrane. 
The strength of the solution should be 20 to 60 minims (1.3-4.0) of the 
distilled extract to the ounce (30.0) of water. Hamamelis when taken 
internally is often very successful in the treatment of uterine oozing 
from small bloodvessels, seems to do good even in hamiatemesis and 
haemoptysis, and will sometimes arrest hematuria when all other 
remedies fail. Applied by means of cloths to recent leg ulcers, it 
rapidly relieves the angry-looking skin surrounding the ulcer. The 
limb should be elevated and at rest while the treatment is pursued. In 
bleeding from the bladder it may be injected into this viscus daily in 
the form of the distilled fluid extract. Taken internally and applied 
locally, it is of value in the treatment of bleeding and the so-called blind 
files. (See Hemorrhoids.) 

Administration. — The official preparations in the U. S. P. are the 
fluid extract (Fluidextractum Hamamelidis Foliorum, U. S. ; Extractum 
Hamamelidis Liquidum, B. P.), dose 5 to 20 minims (0.30-1.30), and 
the distilled extract (Aqua Hamamelidis, U. S., which is a perfectly 
clear fluid, given in the dose of from 30 minims to 1 drachm (2.0-4.0), 
and is much the best preparation for internal and external use. The 
B. P. recognizes a solution, Liquor Hamamelidis, Tinctura Hamamel- 
idis, and Unguentum Hamamelidis. 



HEROIN. 

Heroin is the diacetyl-acid-ester of morphine, and is a white crystalline 
powder without odor and possessing a slightly bitter taste. It is used in 
medicine for the, purpose of controlling excessive cough. Unlike mor- 
phine, its effect on the respiratory centre is stimulant rather than 
depressant when it is given in medicinal doses. Under its influence 
the respirations are usually slightly slowed and deepened. The dose 
is 2V to -g- grain (0.003-0.01) three times a day. Large doses do not act 
as well as small ones as a rule. It is said to be of value in urcemic 



266 DRUGS. 

dyspncea. The fact that it does not stupefy the patient nor produce 
constipation is strongly in its favor. As heroin is insoluble, the hydro- 
chloride of heroin is the preparation used for watery solutions; or 
heroin itself may be dissolved in water to which a little acetic acid 
has been added. It may also be given in pill or powder with white 
sugar. 

HOFFMANN'S ANODYNE. 

Spiritus Mtheris Compositus, U. S. and B. P., consists of alcohol, 
ether, and the heavy oil of wine. The writer has experimentally 
studied very thoroughly the action of the last-named ingredient, and 
finds: 

First. That the belief in heavy oil of wine being the quieting agent 
in Hoffmann's anodyne is fallacious. 

Second. The calmative effects of this mixture depend largely on 
the ether, rather than on the oil. 

Third. It would seem probable that in Hoffmann's anodyne we 
possess an agent in which there are linked together three drugs of 
undoubted power, each one of which successively substitutes the other, 
stimulating the system in the order here named — viz., ether, alcohol, 
and the heavy oil of wine. 

Therapeutics. — Hoffmann's anodyne is the best carminative that 
we possess for general use, and is one of the best remedies for singultus 
or hiccough. This effect is accomplished by the alcohol and ether 
acting as irritants or stimulants to the stomach and intestine, so that 
free peristalsis results. In angina pectoris this drug is often the best 
remedy we have during the attack. In the cardiac palpitation of 
tobacco-heart or in that arising from indigestion and in the nausea and 
depression seen after excessive smoking it is also very useful. 

Hoffmann's anodyne should always be given in capsule or in cold 
water, preferably ice-cold, in order to prevent too rapid volatilization of 
the ether and consequent difficulty in swallowing the liquid. 

The dose is 1 to 2 drachms (4.0-8.0) to an adult. The vapor of the 
ether is so irritating that the drug is difficult of administration to very 
young children. 



H0L0CA1NE. 

Holocaine is a synthetic substance allied to phenacetine, which is 
almost insoluble in cold water, and which is therefore commonly 
employed in the form of the soluble hydrochloride. This salt is a 
white crystalline body, which is stable when brought in contact with 
many agents, but is readily decomposed by alkalies. Solutions of this 
preparation possess distinct antiseptic power, and therefore do not 






\ 



HONEY. 267 

require boiling in order that they may be sterile. As the drug when 
in solution gradually loses its anaesthetic power, it should be freshly 
dissolved each time it is needed. 

Holocaine is used as a local anaesthetic for the eye in place of cocaine, 
usually in the strength of 1 per cent. Its effects begin in about fifteen 
seconds to one minute, and last about five to fifteen minutes. It does 
not dilate the pupil as does cocaine, nor does it affect intraocular ten- 
sion or roughen the corneal epithelium. Holocaine has not supplanted 
cocaine, but, for the reason just given, is useful in cases requiring 
anaesthesia and yet at the same time suffering from keratitis or iritis. 
It does not cause primary ischaemia or secondary hyperaemia of the 
mucous membrane. 

HOMATROPINE. 

Homatropine is an artificial alkaloid obtained by prolonged and 
gentle heating of a solution of equivalent quantities of tropine 1 and 
toluic acid in hydrochloric acid. The hydrobromide of homatropine 
(Homatropinas Hydrobromidum, U. S. and B. P.) is a crystallizable salt 
of homatropine, soluble in 10 parts of distilled water. The B. P. 
recognizes discs of homatropine (Lamellae Homatropince). 

Hydrobromide of homatropine, properly applied by frequent instil- 
lations, is a reliable mydriatic when it is desired to correct anomalies of 
refraction in healthy eyes. Experience is not at hand to determine its 
value for this purpose in eyes affected with retinal-choroidal disturbance. 
Atropine and hyoscyamine are preferred under such circumstances, 
for the obvious reason that their prolonged action is desirable as 
a method of treatment. The danger of systemic disturbance from 
homatropine is remote, even when repeated instillations have been 
made, and its temporary action upon the pulse causes no inconvenience 
to the patient. Slight hyperaemia of the conjunctiva almost invariably 
follows its use, but true conjunctivitis, if it occurs at all, must be 
excessively rare. According to the studies of de Schweinitz and the 
writer, the drug has a physiological action closely allied to that of 
atropine, from which it is derived. Homatropine mydriasis generally 
lasts from thirty-six to forty-eight hours, that of hyoscyamine eight to 
nine days, and that of atropine ten to twelve days. For the production 
of ordinary mydriasis the drug should be used in solution of the strength 
of 4 grains (0.25) to the ounce (30.0) of distilled water, which is to be 
dropped into the eye every five or ten minutes. As the drug is expensive, 
only a few drachms of the solution of the strength named should be 
ordered for a patient. 

HONEY. 

Honey, or Mel, U. S., is the saccharine fluid deposited in combs by 
the honey-bee, or Apis mellifica. It is used in medicine to mask the 

1 Tropine is a product obtained by splitting up atropine into tropine and tropic acid. 



2Q$ DRUGS. 

taste of disagreeable medicines. When it is abstracted from a par- 
ticular variety of flowers, it frequently has the odor of the flowers, and 
when taken internally may even produce the physiological or poisonous 
effects of the plant from which it is gathered. This accident occurs 
commonly in those parts of the country where the bees have had access 
to mountain laurel and similar plants. 

Therapeutics. — Honey mixed with water is used as a vehicle in 
gargles and to relieve cough and dryness of the mouth and fauces. When 
used as a gargle it very distinctly increases the secretion of the mucous 
membrane, and so relieves the congestion. 

Under the name of Oxymel the B. P. recognizes a mixture of 8 parts 
of honey, 1 of acetic acid, and 1 of water. This is generally used as a 
vehicle for more active remedies in gargles or even for expectorant 
mixtures. Melted and strained honey, to which a small proportion 
of glycerin is added, is known as Mel Depuratum, U. S. and B. P. 
There are also a honey of roses (Mel Rosce, U. S.) and a confection 
(Confectio Rosa?, U. S.), used as vehicles for other drugs. Mel Boracis, 
B. P., is used for the same purposes and for stomatitis. 

The objection to the use of honey in vehicles for active medicines 
is the fact that it is apt to disorder the stomach. 

HOPE'S CAMPHOR MIXTURE. 

This is a mixture originally made with nitrous acid, but largely 
used at present with nitric acid, owing to the fact that nitrous acid 
is changed into nitric acid when water is added to it. The nitrous 
acid is, however, more efficacious than nitric acid in the serous or 
choleraic diarrheas which it is used to combat. The formula is as 
follows : 

Bf— Acidi nitrosi . foj (4.0). 

Aquae camphorce f § vii j f 240.0). 

Et adde 

Tinct. opii gtt. xl (2.6).— M. 

S. — One-fourth of this in water every three or four hours. 



HOPS. 

HumuluSy U. S., is the strobiles of ordinary hops, or Humulus 
Lupulus. These contain a liquid volatile alkaloid, lupuline, and a bitter 
principle, lupulinic acid. Hops are known under the name of Lupulus 
in the B. P. Much confusion has arisen in regard to the preparations 
of this drug, partly because Humulus is the official name in the U. S. P. 
and Lupulus in the B. P. This confusion has been increased by the 
fact that the alkaloid of hops is called lupuline, while the powder which 
is found on the strobiles is called lupulin. Those preparations in the 
U. S. P. having the word "humulus" in their name are made from 



HYDRASTIS. 269 

the hops themselves, those with "lupulin" in their name from the 
powder of the strobiles. 

Therapeutics. — Hops are used as antispasmodics and nervous seda- 
tives in cases of hysteria and nervousness. In priapism, vesical irrita- 
bility, and renal irritation they are of service. Even in delirium tremens 
they seem to be of value. For local application a hop poultice may be 
made by placing the powdered strobiles in the mass, and employed 
in this way they are a favorite domestic remedy for local painful 
inflammations. Hops have been used in the form of a hop pillow 
in nervous insomnia, but the soporific influence is largely imaginary 
or depends on the fumes of the alcohol with which the pillow is 
moistened. 

Administration. — The tincture (Tinctura Humuli) is given in the 
dose of \ to 3 ounces (16.0-90.0). Lupulin (Lupulinum, U. S. and 
B. P.), which is the powder found on the strobiles of hops, is given 
in the dose of 2 to 5 grains (0.12-0.30) or more; the oleoresin of 
lupulin (Oleoresina Lupulini, U. S.) is given in dose of 10 to 40 
minims (0.60-6.20) in capsule; and the fluid extract (Fluidextr actum 
Lupulini, U. S.), in the dose of 30 to 120 minims (2.0-8.0). The 
preparations of the B. P. are the infusion (Jnjusum Lupuli), dose 1 
to 2 fluidounces (30.0-60.0), and the tincture (Tinctura Lupuli), dose 
i to 2 fluidrachms (2.0-8.0). 



HYDRASTIS. 

Hydrastis, U. S., or Hydrastis Rhizoma, B. P., is the rhizome of 
Hydrastis Canadensis, sometimes called Golden Seal, containing two 
alkaloids known as hydrastine and berberine, and, perhaps, xantho- 
puccin. 

Physiological Action. — When given to one of the lower animals in 
poisonous doses hydrastis may cause spinal convulsions followed by 
paralysis, according to the quantity of berberine or hydrastine present. 
The latter is more convulsive in its effects than the former. Upon 
the circulation hydrastine, when injected into the jugular vein, causes 
a primary fall of arterial pressure, succeeded by a decided rise, and 
the studies of Cerna have proved that it is an active poison. When 
given to man in medicinal amounts its effect on vital functions is very 
slight indeed. 

Therapeutics. — Hydrastis is of service in chronic gastro-intestinal 
catarrh, particularly that following the abuse of alcohol, and may be 
used as a stomachic and tonic after malarial fever and similar depress- 
ing diseases. Wherever membranes are in a condition of lowered 
tone this drug is indicated. Thus in catarrhal jaundice of a subacute 
type, in uterine catarrh, in leucorrhwa dependent upon a relaxed state 
of the vagina, and in chronic nasal inflammations and irritations it 
will be found useful. 



270 DRUGS. 

Tincture of hydrastis is said to possess a distinct antimalarial influ- 
ence, but this is doubtful. 

One of the best remedial measures that we have in the later stages 
of gonorrhea, when the acute period has passed, is the local and inter- 
nal use of hydrastis. If it is used as an injection, 5 grains (0.3) of the 
commercial hydrastine to each ounce (30.0) of water should be em- 
ployed twice a day. Belfield has highly recommended the following 
formula for use in this disease prior to the tenth day: 

]^ — Hydrastin. hydrochloride gr. v (0.3). 

Protargol gr. v (0.3). 

Glycerin f3ss (0.2). 

Aquse destillat q. s. ad f §j (30.0).— M. 

S. — Precede with a hot-water injection and use four to six times daily, telling 
the patient to retain it five to ten minutes each time. 

The following infusion will be found of service in vaginal gonorrhea 
and leucorrhcea: Take 1 drachm of the powdered root and add it to 8 
ounces of boiling water; \ to 1 drachm of the fluid extract may also 
be added to a pint of water and used as a wash. 

Administration. — The fluid extract (Fluidextractum Hydrastis, 
U. S. : Extractum Hydrastis Liquidum, B. P.) may be given in the dose 
of 5 to 30 minims (0.30-2.0), while the dose of the tincture (Tinctura 
Hydrastis, U. S. and B. P.) is from 30 minims to 2 drachms (2.0-8.0.) 
The Glyceritum Hydrastis, U. S., is used as a healing application to 
mucous membranes. 

Much doubt exists as to the dose of hydrastine. This arises from 
the fact that two forms of it are sold. The most commonly seen is 
a dark-brown mass which is very impure, and contains berberine and 
other substances. Its dose is 3 to 10 grains (0.20-0.60). The pure 
hydrastine (Hydrastina, U. S.), as made by Merck, is given in the 
dose of J to \ grain (0.015-0.03). Hydrastinine hydrochloride, an 
artificial alkaloid of hydrastine, is official in the U. S. P., dose \ to 1 
grain (0.03-0.06). 

HYDROBROMIC ACID. 

(See Bromides.) 

HYDROCHLORIC ACID. 

Acidum Hydrochloricum (U. S. and B. P.) is a clear, colorless 
liquid, possessing an acid odor and taste, devoid of astringency, but 
in concentrated form decidedly caustic. It should be kept in dark- 
colored bottles. In the strength of 0.2 per cent, it is normally present 
in the gastric juice, and aids the pepsin in the conversion of proteids 
into peptones and in the formation of pepsin from pepsinogen. 

Therapeutics. — Hydrochloric acid is indicated only in certain forms 
of indigestion. With new methods of studying gastric secretions we 
have learned that it is of value in those cases in which the gastric 
secretion of HC1 is deficient. Thus it is given to aid digestion during 



HYDROCYANIC ACID. 271 

and after fevers, when this acid is apt to be absent from the gastric 
juice, particularly in typhoid fever. In cases of gastric cancer, when 
this acid is usually absent from the gastric secretion, and in the sick 
stomach following an alcoholic debauch, it is of great service. In 
some cases of chronic gastric catarrh with dilatation, in which there is 
atrophy of the gastric tubules, it should be used freely. The dose of 
the dilute acid (Acidum Hydrochloricum Dilutum, U. S. and B. P.) is 
5 to 20 minims (0.30-1.3). 

A useful prescription in such cases is: 

fy— Acid, hydrochloric, dil f 3ij (8.0). 

Pepsin, essence . . f 5j (30.0). 

Tinct. gentian, comp. . . . q. s. ad f§iv (120.0). — M. 
S. — Dessertspoonful (8.0) in a little water with meals. 

This acid is combined with nitric acid to form dilute nitro-hydro- 
chloric acid (Acidum Nitro-hydrochloricum Dilutum, U. S. and B. P.), 
the dose of which is 10 to 30 minims (0.60-2.0); also the pure acid 
(Acidum Nitro-hydrochloricum, U. S.), dose 1 to 5 minims (0.05-0.30). 

Hydrochloric acid causes, when taken in poisonous doses, violent 
gastro-enteritis and corrosion of the gastric walls, and its action should 
be combated by alkalies, soap, oils, and white of egg, and the use of 
opium to relieve pain and irritation. 



HYDROCYANIC ACID. 

Hydrocyanic or Prussic Acid is a transparent, colorless, very volatile 
liquid, giving rise to vertigo when inhaled in minute amounts and 
capable of producing death if the fumes be concentrated. If the bottle 
containing the pure drug be opened, it should be done where there is 
sufficient draught between windows to prevent any contamination of 
the atmosphere of the room by the acid. 

Pure hydrocyanic acid is never used in medicine; the form employed 
is the dilute acid (Acidum Hydrocyanicum Dilutum, U. S. and B. P.), 
which contains about 2 per cent, of the drug. It must be kept in dark, 
tightly-stoppered bottles. 

Physiological Action. — This is one of the most rapid (if not the most 
rapid) of the lethal poisons, only being approached by carbolic acid and 
nitrobenzole in the violence of its effects. Owing to its volatility, it is 
absorbed with great rapidity, and acts upon the respiratory centre and 
the heart, being eliminated almost immediately afterward. Because of 
its fleeting character, the survival of a patient twenty or thirty minutes 
after the ingestion of a poisonous dose is a favorable sign for his recovery. 

The drug is an active paralyzant and exerts a lethal influence over 
every part of the body. The nervous system, heart, respiration, brain, 
and all vital parts are killed at once if much of it is present. 

Poisoning. — When a lethal dose of hydrocyanic acid is taken, death 
either comes at once, so that the person drops dead with a gasp, is for a 



272 



DRUGS. 



moment convulsed, the face cyanotic, the eyes wide open, with the teeth 
tightly clinched, and the lips covered by a bloody froth, or three stages 
of poisoning may ensue if the dose has not been large enough to 
result in immediate death, owing to its slow absorption. In the first 
of these stages there are difficult respiration, slow cardiac action, and 
disturbed cerebration. In the second stage, which is convulsive, 
there are present wild cries, dilated pupils, unconsciousness, vomiting, 
spasmodic urination and defecation, erections of the penis, and ejacula- 
tions of semen. In the third stage there are asphyxia, collapse, and 
paralysis, ending in death. The blood is found to be dark and 
venous-looking, but does not give the spectrum bands of cyano- 
hsemoglobin. These bands only appear when the drug is shaken 
with blood outside the body. 

The diagnostic signs of death from prussic acid are the odor of the 
body, the wide-staring eye, the clinched teeth covered with froth, and 
the livid, cyanosed face. If the body be opened, the odor of hydro- 



Fig. 47. 




Tracing of the deep stormy respirations of an animal under the influence of hydrocyanic acid. 
(After Schmiedeberg.) I. Normal respirations; II. Acid inhaled; III. Violent deep respirations; 
IV. Arrest of respiration. 



cyanic acid is marked, but this rapidly passes away, owing to the vola- 
tility of the drug. 

The only poison producing symptoms resembling those which have 
just been described is nitrobenzole or essence of mirbane, which has 
a somewhat similar odor, but which is, however, more permanent, the 
odor remaining for hours in the opened body, 

Therapeutics. — Hydrocyanic acid is useful in cases of gastralgia of 
purely nervous origin, and in some cases of nervous vomiting, and in 
irritable stomach, where, owing to hyperesthesia of the mucous mem- 
branes, the taking of food produces discomfort. 

In irritable coughs, due to tickling in the throat and bronchi, it is 
very extensively used, and has received high praise by those best 
qualified to judge. On the other hand, it has been claimed that owing 
to the extreme volatility of the drug it acts only for the moment, and 
that a dose every ten or fifteen minutes is necessary to produce any 
constant effect. However this may be in theory, practically the acid 



HYDROGEN PEROXIDE. 273 

certainly does aid in relieving cough. In these states the following 
prescription will be found of service: 

1^— Acid, hydrocyan. dil f 3j (4.0). 

Syrup, pruni virg fgiij (90.0). — M. 

S. — Teaspoonful (4.0) every four or five hours to an adult. 

In enteralgia or neuralgia of the intestine dilute prussic acid is 
often a very useful remedy. 

Externally, the drug is useful in pruritus and other forms of itching 
skin diseases, and the following formula will be found of service in 
pruritus vulva?: 

1 Bj, — Hydrarg. chlor. corros gr. iss (0.09). 

Acid, hydrocyanic, dil f5j (4.0). 

Aquae amygdal. amarse fovj (180.0). — M. 

S. — Poison! For external use. Apply to the itching surface with a small rag. 

The same prescription may also be employed in pruritus without 
the bichloride, if so desired. The dose of dilute hydrocyanic acid is 
1 to 5 minims (0.05-0.30). In certain forms of irritable cough inhala- 
tions of the vapor (Vapor Acidi Hydrocyanici) are recommended; 
this is prepared by adding 10 to 15 minims (0.60-1.0) of the diluted 
acid to 1 fluidrachm (4.0) of water, which is then placed in a suitable 
apparatus, from which is inhaled the vapor that arises. 



HYDROGEN PEROXIDE. 

Peroxide of Hydrogen is a clear, odorless, syrupy fluid of a specific 
gravity of 1.452, possessing a harsh, bitter taste. It is readily soluble 
in water, and its chemical formula is H 2 2 . Pure peroxide of hydrogen 
is never used in medicine, but in solutions of varying strength. The 
ordinary solution, as found in the shops and that now official (Aqua 
Hydrogenii Dioxidi, U. S.; Liquor Hydrogenii Peroxidi, B. P.), is 
about 3 per cent., or, as it is generally called, a 10- volume solution. 
This term, "10 volumes," signifies that it can yield 10 volumes of 
available oxygen; and it is upon this yield of oxygen that its activity 
depends. The specific gravity of this official solution is 1.006 to 1.012 
at 59° F. The reaction is acid, but this is due to a small amount of acid 
added to the solution to preserve it. The official solution of peroxide 
of hydrogen, while the most stable that can be prepared, is neverthe- 
less readily deteriorated by exposure to heat, sunlight, or prolonged 
shaking. If placed in an absolutely clean, smooth glass vessel, it may 
be concentrated for immediate use by exposing it to a temperature of 
140° F.; but exposure to a temperature above this point may result 
in its decomposition with explosive violence. Practically, this means 
of concentration is not convenient for the practitioner, and the ordinary 
official solution fulfils all ordinary requirements unless it has deterio- 
rated by age. The great difficulty in the use of the solution of the 
peroxide is its liability to undergo a change and become practically 

18 



274 DRUGS. 

worthless. Wallian states that as a rough test for the value of a given 
solution a few crystals of permanganate of potassium may be placed 
in a test-tube, and 1 or 2 drachms (4.0-8.0) of the solution added. 
The violence of the resulting effervescence is in direct ratio to its value 
as a remedial agent. Marshall has proved that the constituent of 
blood and pus that sets free the oxygen from this drug is globulin. 

Therapeutics. — The most valuable use of the peroxide-of-hydrogen 
solution in medicine is in the treatment of diphtheria. So far as we 
know, it is the best application for the destruction and removal of the 
false membrane. There is no injury to the normal tissues, nor is there 
the danger of poisoning which sometimes follows the use of such drugs 
as carbolic acid. Applied to the false membrane, there is at once an 
active effervescence with some local tingling of the part. The mem- 
brane can afterward be removed in shreds. The solution should 
be applied by means of a swab or spray, but if the latter is used a 
glass atomizer must be employed, as the peroxide is decomposed by 
coming in contact with metals. Peroxide of hydrogen is also a very 
valuable application for cases of follicular tonsillitis with profuse exu- 
dation, to cleanse the parts prior to the use of guaiacol. (See Guaiacol.) 

In the treatment of abscess-cavities, tubercular or septic in character, 
the peroxide of hydrogen is a very valuable application, and its use 
will often decide the presence of pus, since when it meets with this 
material active effervescence ensues; but care must be exercised that 
free vent is allowed for the gas that is given off, as if confined it will 
force the septic material into the surrounding healthy tissues. Simi- 
larly, it is a valuable preparation for cleansing ulcers and malignant 
growths which have ulcerated. 

Hydrogen peroxide is a useful agent for the removal of powder- 
stains in recent cases. 

It is stated that the application of this liquid to the spot affected 
by a hornet's sting will give instant relief; and applied by means of 
an atomizer it is the best fluid to aid in the painless removal of ad- 
hesive strips. The part of the strip next the skin should be sprayed as 
it is gradually pulled off. It is also used on plaster-of-Paris dressings 
to soften the material so that it can be cut with a knife or shears. 

Where the peroxide is used as a gargle it may produce pain through 
its attacking cavities in the teeth or the metallic substances with which 
they are filled. 

The employment of the peroxide internally, with the idea that it 
will yield oxygen to the body in cases in which this gas is lacking in 
the blood, is futile. Even if the oxygen entered the blood, the amount 
disengaged from a possible dose would be too small to be of value. 

Taken internally, the peroxide of hydrogen is not poisonous. The 
internal dose of the Aqua Hydrogenii Dioxidi of the U. S. P. is from 
1 to 4 drachms (4.0-16.0), well diluted with water, and taken from a 
porcelain, not a metal, cup or spoon. It possesses no distinct value 
in internal medication. 



HYOSCYAMUS. 275 



HYOSCYAMUS. 



Hyoscyamus, U. S., or Henbane, is a plant of the Northern United 
States and Europe. The leaves (Hyoscyami Folia, B. P.) only are 
used, and from them are obtained two alkaloids — one known as hyos- 
cyamine, the other as hyoscine. The first has practically the same 
physiological action as atropine, save that it is much more sedative in 
its effects on the nervous system. (See Belladonna.) The second is 
quite different in its influence over the body. The only marked differ- 
ence in the action of hyoscyamine and atropine is in the mydriasis pro- 
duced by each. While that of atropine lasts, in man, from twelve to 
fourteen days, hyoscyamine generally remains for only seven to nine 
days. Sometimes the development of mydriasis is preceded by violent 
pain in the eye due to a cramp of the ciliary muscle. If so, the drug 
must be pushed to overcome the spasm. The strength of the solution 
to be used in 2 grains (0.12) to the ounce (30.0). Owing to the presence 
of hyoscine in hyoscyamus, it is more quieting and depressing to the 
nervous system than is belladonna. 

Therapeutics. — Hyoscyamus is used in every condition indicating 
the employment of belladonna; or, in other words, wherever local 
spasm or arterial relaxation exists or where pain is due to spasm. It 
has been particularly recommended in nervous cough, in whooping- 
cough, and in colic, and probably is better in its influences in these 
states than is belladonna. In combination with nitrate of silver the 
extract may be used with advantage in chronic gastric catarrh and 
gastric ulcer. In urinary incontinence due to irritable bladder it is 
very serviceable, and particularly is this true of this affection in chil- 
dren and old persons, provided that the urine is first rendered normal 
by the use of acidifying drugs or by the use of alkalinizing drugs if it 
is abnormally acid. 

Administration. — The drug itself is official in four forms and as 
hyoscyamine sulphate and hydrobromide. The dose of the tincture 
(Tinctura Hyoscyami, U. S. and B. P.) is 10 to 40 minims (0.60-2.60) ; 
the alcoholic extract (Extractum Hyoscyami, U. S., and Viride, B. P.), 
dose i to 1 grain (0.03-0.06) ; the alkaloid (Hyoscyamine Sulphas, 
U. S. and B. P., vel Hydrobromidum, U. S.), dose -fa to -fa grain 
(0.001-0.0015) ; and the fluid extract (Fluidextr actum Hyoscyami, 
U. S), dose 2 to 10 minims (0.10-0.60). The B. P. preparation, besides 
those given, is the juice (Succus Hyoscyami), dose 30 minims to 1 
fluidrachm (2.0-4.0). 

Hyoscine. 

This is one of the alkaloids derived from hyoscyamus, and is a thick, 
syrupy substance which forms a crystalline salt with an acid. It has 
been entirely supplanted by scopolamine, to which the name Hyoscine 
has been given. 



276 DRUGS. 

Hyoscine is official in the form of Hyoscine Hydrobromide (Hyos- 
cinoB Hydrobromidum, U. S. and B. P.). b 

Physiological Action. — Hyoscine quiets the cerebrum and produces 
deep sleep in a certain class of patients. In the lower animals or in 
man it may cause sleep or wild delirium. It causes loss of reflex action 
in overdose, which is due to depression of the spinal cord and not of 
the nerve-trunks. Upon the circulation it has little effect, but it is 
worthy of note that it influences the vagus nerves, as does atropine, 
stimulating them at first, but finally depressing them, although the 
contrary has been asserted. In any event, the circulatory effect is a 
minor one. 

In cases where hyoscine has acted in excess, or where an overdose 
has been given, pilocarpine may be used as a physiological antidote 
in full doses if the heart is sound. 

Therapeutics. — Hyoscine is of value as a hypnotic in a very limited 
class of cases, and in this class generally acts most favorably. These 
cases consist of those who, from acute mania, hysteria, or similar cause, 
suffer from insomnia, and perhaps struggle violently against proper 
control or refuse to swallow or retain food. 

The drug may be given to such persons hypodermically, in the 
dose of tfo ^To g ram (0.0006), or by the mouth in the dose of ■£$■ to 
-g 1 ^- grain (0.0008). The fact that it possesses no taste and is small in 
bulk renders it readily employed. In some persons it utterly fails even 
in this particular type of case. In delirium tremens it may cause 
evidences of cerebral congestion and Cheyne-Stokes breathing, but, 
on the other hand, it very commonly aids in combating chronic 
alcoholism when given in very large dose. (See below.) Some patients 
are not quieted by the drug, but pace up and down in a semi-sane con- 
dition until its action wears off. Such symptoms can best be overcome 
by using larger doses. 

Recently hyoscine has been highly recommended in the treatment 
of the morphine and alcohol habit, and there can be no doubt that it 
is an excellent remedy. The patient must be under complete control 
and should be given enough hyoscine hypodermically to be thoroughly 
under its influence, as much as ^p- grain being given every two hours 
if need be to keep him quiet. Aside from great dryness of the tongue 
and the characteristic delirium caused by the drug, no evil effects ensue 
and the patient usually without much suffering, recovers from the 
effects of the narcotic drug to which he is a slave, and in a good 
general state so far as his nerves are concerned. 

Hyoscine is of great value in some cases of spermatorrhea and 
nocturnal emissions if given in the dose of ytto g ram (0.0006) at bed- 
time. 

The drug is contraindicated in the sore throat of scarlet fever, as 
it may cause a sensation of pharyngeal constriction. In the insomnia 
of heart disease with nervousness it will cause sleep, but often fails. 

Hyoscine is used by ophthalmic surgeons, and in the eye is far less 
irritating than atropine. Indeed, it may be considered as being dis- 



ICHTHYOL. 277 

tinctly sedative in plastic iritis. Its effects are not, however, so last- 
ing as are those of atropine; ^g-g- grain dropped into the eye in one 
dose produces mydriasis in eighteen minutes and ciliary paralysis in 
twenty-three minutes; this mydriasis lasts about twenty-two hours, 
and the ciliary paralysis about ninety-six hours. (Oliver.) It finds 
its greatest usefulness in the early stages of iritis, when a rapidly 
acting and efficient sedative mydriatic is demanded. Hyoscine is best 
used for thii purpose in the strength of 0.2 per cent. (1 : 500) in water. 
This solution may be dropped into the eye every twenty minutes till 
one hour has elapsed. As this use of the drug is slightly painful, it 
is well to place a few drops of cocaine solution in the eye before 
each instillation of hyoscine. 

HYPNAL. 

The chemical name of this substance is monochloral-antipyrine, 
and it is, as its name indicates, a compound of chloral and antipyrine. 
There is also a dichloral-antipyrine, which contains more chloral. The 
compound is employed in treating those patients who suffer from pain 
and insomnia combined, the antipyrine relieving the pain and the 
chloral producing sleep. Opium is the only drug known which can 
be relied upon to act in this double manner, and the disadvantages of 
that medicament are often so prominent as to prevent its use. The 
drug has been used in neuralgic insomnia, but for some reason has not 
proved as popular as was expected when it was introduced. The dose 
is from 5 to 20 grains (0.3-1.3), best given with simple syrup and 
water or with syrup of orange-peel, or it may be used as follows: 

1^ — Hypnal gr. xv (1.0). 

Chartreuse f 3j (4.0). 

Distilled water f §ss (16.0).— M. 

S. — The entire amount to be taken in one dose. 



ICHTHYOL. 

The substance sold in the shops and employed in medicine under 
the name of ichthyol is a salt formed by the bibasic acid ichthyo- 
sulphuric or sulpho-ichthyolic acid with ammonium. In other words, 
it is ammonium ichthyol, which is a semi-solid substance. The 
ichthyo-sulphuric acid itself is derived from a crude oil, which in turn 
is obtained by destructive distillation from a deposit of fossil fish found 
in the Tyrol Mountains. When combined with sodium, forming 
sodium ichthyol, a more solid substance than ammonium ichthyol is 
formed, which can be employed if it is desired to use the drug in pill 
form. Both the ammonium and sodium ichthyol contain about 10 per 
cent, of sulphur, and it is largely upon this that their therapeutic 
activity depends. They are both soluble in water, and have a dark- 



278 DBUGS. 

brown, tarry appearance. Their disagreeable odor is due to an 
inseparable volatile oil. 

Therapeutics. — Ichthyol is without doubt one of the most remark- 
able substances introduced for medicinal purposes within the last few 
years, both because of its curious origin and its therapeutic value in a 
large variety of ailments. In the author's hands it has proved most 
efficacious in the treatment of the inflamed areas in acute articular 
rheumatism. When used in this disease an ointment composed as fol- 
lows is to be smeared over the inflamed part, and then spread on lint, 
which is wrapped about the limb. This usually relieves the pain and 
tenderness of the part to a great extent. The same application, accom- 
panied by rubbing or applying massage to the joint, is of value for the 
pain and stiffness met with after the acute manifestation of the disease 
has passed by: 

I*— Ichthyol 5ss (16.0). 

01. citronellse gtt. xv vel xxx (1.0-2.0). 

Adipis vel lanolini §j (30.0). — M. 

The same prescription is also the best external treatment of erysip- 
elas that we have. The skin should be carefully and gently washed, 
and then anointed with the ointment and covered by lint smeared 
with this ointment. If the disease be in the skin of the face, holes are 
to be cut in the lint for the mouth, nose, and eyes. Ichthyol is also a 
very useful drug in the treatment of chronic skin diseases associated 
with atony and induration of the deeper layers of the skin, such as 
acne, eczema, and even lupus and keloid in their chronic stages. It is 
always better to use ichthyol in ointment form, but some practitioners 
have employed it by painting it on in watery solution with a cameFs- 
hair brush. In frostbites, chilblains, and in burns it is of service, and 
Agnew recommended it highly when rubbed into lymphatic enlarge- 
ments. Ichthyol has proved remarkably efficacious in removing peri- 
uterine and other pelvic exudations when used as a salve with pelvic 
massage or in a vaginal suppository. 

For acute sprains, and for the removal of the swelling following 
such injuries, its influence is extraordinary if it be well rubbed into 
the part affected. 

In severe cases of cracked nipples, with much induration, an oint- 
ment of ichthyol, 1 to 4 drachms (4.0-16.0) of lanolin, will prove of 
value, but it must be wiped off before each nursing or the child will 
not take the breast. Often the odor remains and prevents nursing. 

The dose of ichthyol internally is 1 to 10 grains (0.06-0.60), given 
in pill. 

Ichthyol is a very useful remedy for the treatment of fetid ozama. 
(See Nasal Catarrh, Atrophic? Part IV.) 

IODIDES OF AMMONIUM AND ETHYL. 

(See Ammonium and Ethyl Iodide.) 



IODIDE OF POTASSIUM, 279 

IODIDE OF POTASSIUM. 

The physiological effects of iodide of potassium (Potassii Iodidum, 
U. S. and B. P.) are entirely comparable to those of iodine itself (see 
Iodine), but it is employed for somewhat different purposes, is less 
irritant, more readily given, and perhaps more readily absorbed. 
When it is given in very large doses or for a long period of time, the 
fact that the potassium base is a depressant poison is to be remembered, 
and it is well to use iodide of sodium instead. 

Physiological Action. — Circulation. — Upon this part of the sys- 
tem when in health iodide of potassium produces effects differing very 
slightly, if at all, from those caused by potassium itself. Small amounts 
raise the blood-pressure, and large quantities lower it (Prevost and 
Binet), but if atheroma of the bloodvessels be present with high arterial 
tension in association with it, iodide of potassium acts as a valuable 
remedy in reducing the vascular spasm. It therefore lowers arterial 
pressure. 

Absorption and Elimination. — Iodide of potassium is very rapidly 
absorbed and eliminated, appearing in the urine, according to Doux, in 
thirteen minutes after it is ingested, and the daily amount excreted 
equals about 80 per cent, of the dose taken. Some of the drug tends to 
accumulate in the body. It is evident, therefore, that in the use of 
iodide of potassium we should give it freely and frequently at first until 
the residual amount has reached its limit, when smaller doses may be 
given, and given less frequently, for the purpose of maintaining the 
iodine influence. That is to say, the drug should be given up to the 
point of tolerance, whatever that may be, and then a smaller dose will 
be sufficient to maintain its influence by replacing the albuminoid 
compounds of iodine as they are slowly eliminated. On the other 
hand, if the iodide is being given for the purpose of eliminating some 
poison, as lead, for example, here the dose cannot be greatly decreased, 
because in addition to the ordinary quantity eliminated a portion is 
passed out as a double soluble iodide of lead. This theoretical deduc- 
tion seems to find support in the fact that after the syphilographer 
reaches the full effect of the drug he often cuts the dose down to what 
he calls the "tonic dose/' and so maintains the constant alterative effect 
without disordering the functions of the body. If he does not do this, the 
drug accumulates and causes chronic iodine cachexia, a state which it is 
important to avoid in grave diseases like syphilis, which depend for 
their relief so largely on the maintenance of vitality in the patient. All 
traces of the iodine in the urine disappear four or five days after the last 
dose is administered (Elhers). 

Therapeutics. — The medicinal uses of iodide of potassium may be 
divided into three great divisions, each of which is important. It is also 
employed for many conditions not included in these classes : 

1. Syphilis. — The use of iodide of potassium in syphilis is recog- 
nized as a part of all treatment for its relief. Elsewhere Dr. Martin 
has, in his excellent article (see Syphilis), treated of this question, and 



280 DRUGS. 

it is only necessary to call attention to the fact that the drug is generally 
well borne in large amounts by advanced syphilitics, although this is 
not always the case. The term "therapeutic test" is applied by one 
eminent teacher to signify a state of the system produced by syphilis in 
which a diagnosis may be made by the fact that large doses of the iodide 
are borne without inconvenience. This resistance does not always 
prove the presence of syphilis, nor does the absence of this resistance 
prove the absence of this disease. Persons having hereditary asthma, 
gout, rheumatism, or some similar diathetic malady often resist the 
iodide, and, on the other hand, some syphilitics exhibit "iodism" 
after very small doses. In treating syphilis the drug should be used 
in the dose of 10 grains (0.60) three times a day, and this amount 
gradually increased a grain a day until symptoms of "iodism" occur. 

The quantity borne often amounts to from 100 to 200 grains (6.6- 
13.2) a day, and as much as 400 grains may be taken by some persons. 
The best way to use the iodide of potassium is to order for the patient 
a saturated solution of the drug, which contains in each drop about 1 
grain, and at the same time a bottle of the compound syrup of sarsa- 
parilla. To a tablespoonful of the latter the patient is to add the iodide 
solution, beginning with 10 minims (0.60) three times a day, and 
increasing a minim every twenty-four hours. 

The iodide acts more slowly as an antisyphilitic than does mercury. 

In tertiary syphilis the iodide is invaluable. 

In nervous syphilis, be its manifestations what they may, iodide of 
potassium is the standard remedy, being supplanted by mercury only 
when it is necessary to break down a growth whose existence is a daily 
menace to the patient's life, as, for example, a brain tumor which 
causes pressure near vital areas. It is not curative in sclerotic post- 
syphilitic changes nor in locomotor ataxia due to syphilis, except in the 
earliest stages, because destroyed cells cannot be restored, but it can be 
used to arrest further advance of the disease. It may greatly improve 
the patient's condition by preserving cells not as yet entirely destroyed. 

The therapeutic effect of this drug is much increased if hot vapor 
baths are used simultaneously with its internal administration. 

2. Metallic Poisoning. — Owing to the fact that iodide of potas- 
sium forms soluble double salts with all the metals in the tissues in 
chronic poisoning, thereby aiding in their elimination, it should always 
be employed in chronic lead, zinc, arsenic, or mercurial poisoning. 

3. Antirheumatic. — Iodide of potassium is best suited, not to 
acute articular rheumatism, when the joints are very hot and painful, 
but to the secondary or subacute types, when the joints are enlarged • 
and the case " hangs on" — now better, now worse. It acts best, under 
these circumstances, if combined with wine of colchicum-root. (See 
Rheumatism.) It is also to be tried in sciatica, lumbago, and rheumatic 
neuralgia, and it may be employed in chronic pleurisy, pericarditis, 
and hydrocephalus to cause absorption of the fluids. In these con- 
ditions, however, it often fails and cannot be relied upon. 

In aneurism, particularly that of the aorta, the drug often does good, 






IODIDE OF POTASSIUM. 281 

but its value rests largely upon the cause of the disease. If it is due to 
syphilis x the aneurism may speedily cease to grow under its influence, 
and the pain, swelling, and pulsation gradually decrease. 

In asthma iodide of potassium is valuable if the disease is of the pure 
bronchial type, but it ought not to be employed if the cause is associated 
with gastric irritation or indigestion, as it makes the condition of the 
stomach worse. In bronchitis and intestinal catarrh where the con- 
dition of the mucous membranes is semi-chronic, and not relieved by 
chloride of ammonium, iodide of potassium should be used. If the 
bronchitis is chronic and the secretion profuse (bronchorrhcea), iodide 
of potassium will make it worse. The dose for an adult in all these 
instances should be about 3 to 5 grains (0.20-0.3) three times a day, 
for small doses tend to increase secretion far more than large ones, 
which often seem to decrease it. In "pulmonary emphysema iodide of 
potassium is often of great value. 

In chronic interstitial nephritis small doses (5 grains [0.3] t. i. d.) 
are thought by some to check the disease, but it is to be remembered 
that the drug may produce untoward symptoms if the kidneys do not 
eliminate it, so that, if used at all, it must be given with great care. If 
the drug is well borne in chronic parenchymatous nephritis, it will 
cause an extraordinary increase in the urinary flow, and will often 
relieve very rapidly any dropsy which may be present. 

In bronchocele the employment of iodide of potassium internally and 
tincture of iodine externally is the best treatment we can use, and in 
acute coryza, or "cold in the head," 10 grains (0.60) taken at the begin- 
ning of the trouble will often abort the attack. 

In hepatic cirrhosis, in its early stages, the iodide often does good 
in arresting the overgrowth of connective tissue, and in arteriosclerosis 
or atheroma of the bloodvessels it is of great service. Thus in the 
latter conditions a combination of iodide of sodium or potassium with 
a little digitalis will relieve vascular spasm and support a feeble heart. 

A very important use of iodide of potassium is for the removal of 
enlargements of the cervical glands and those occurring in other parts 
of the body. Full doses are useful in actinomycosis. In the later 
stages of pneumonia the iodides are useful to aid in the absorption of 
any exudates, but they are contraindicated in phthisis, except in the 
fibroid form and in those cases which are dependent upon syphilis as 
an underlying dyscrasia, as they aid in the breaking down of the lung. 

Untoward Effects. — In some persons, after the use of the iodide, 
coryza comes on, so that the edges of the eyelids become reddened 
and the nose runs constantly; and it is a curious fact that small 
doses are more apt to produce such a result than large ones. This is 
followed, if the drug is pushed, by the more positive signs of "iodism" 
spoken of under Iodine. 

In other cases acne breaks out on the face and disorders of digestion 
and gastric irritability come on. The acne can nearly always be pre- 
vented by giving arsenic at the same time with the iodide. In some 
cases petechial rashes break out on the legs, while in others great 



282 DRUGS. 

mental and physical depression appears, so that listlessness or 'melan- 
cholia may develop. Sometimes iodide of potassium causes diarrhoea. 

In persons susceptible to iodide of potassium care should be exer- 
cised when it is first administered lest sudden and dangerous oedema 
of the glottis occur. Eisner has reported a case in which death due to 
this cause followed the administration of 30 grains of the iodide of 
potassium. Multiple hemorrhages from the skin and mucous mem- 
brane occurred. 

If bullae or blebs follow the use of the iodides or other rashes appear, 
it is said that atropine will afford relief. 

Sometimes the iodide of ammonium or iodide of sodium will be 
borne when the iodide of potassium will not. 

Administration. — The iodide of potassium, owing to its exceed- 
ingly disagreeable taste, should be given with the compound syrup 
of sarsaparilla, as already described, with fluid extract of liquorice, or 
in milk. Large amounts of these vehicles are to be used. A good way 
tc fi^ive it is to add the drug to one of the liquid pepsins, and then to add 
this to warm milk, as in the directions for the preparations of junket 
given in Part III. The curd largely disguises the taste of the drug. 
The dose usually varies from 5 to 60 grains (0.30-4.0) three times a 
day,, according to the condition of the patient. It is best given an 
hour after meals, so that it will not disorder digestion by irritating 
the stomach or interfere with the action of the gas ric juice. 

One of the best ways to take the drug is in capsule, but if this is done 
a drink of milk or water or other fluid should precede or follow it, in 
order to prevent the drug from coming in contact with the stomach in 
concentrated form. The preparations of the iodide of potassium are — 
Unguentum Potassii Iodidi, U. S. and B. P., and the liniment (Lini- 
mentum Potassii Iodidi cum Sapone, B. P.). The former should 
always be freshly prepared. 



IODIDE OF SODIUM. 

Sodii lodidum, U. S. and B. P., is used in the same doses and for the 
same purposes as the iodide of potassium, and is less irritant than the 
latter salt, as well as less depressant to the general system. 



IODINE. 

lodum, U. S. and B. P., is a non-metallic element found largely in 
seaweed and in mineral iodates and iodides. It is soluble in ether and 
alcohol, but slightly so in water, and possesses an acrid, burning taste 
and a neutral reaction. 

Physiological Action. — The physiological action of iodine, so far as 
its alterative powers are concerned, is absolutely unknown. Applied 
to the skin, it stains it yellow, brown, or black according to the free- 
dom of its application, and it acts without pain if the skin is intact. 



IODINE. 283 

If very large amounts are used, it produces vesication. Upon mucous 
membranes iodine acts as a powerful irritant. Germain-See believed 
it to be a stimulant to the nutritive processes of the body and to the 
circulatory system, and he was certainly correct in regard to the influ- 
ence it exercises over nutrition. 

Absorption and Elimination. — The drug is rapidly absorbed, 
escapes from the body chiefly through the kidneys, the skin, the salivary 
glands, and it even appears in the milk of nursing women to such an 
extent that the nursing infant may be affected by iodism and suffer 
from gastro-intestinal disturbance in consequence of ingesting it. 

Poisoning. — The symptoms of acute poisoning by iodine are those 
of acute gastro-enteritis, such as severe pain in the oesophagus, stomach, 
and abdomen, accompanied by violent vomiting and purging. An 
early symptom is the persistent strong metallic taste in the mouth, 
with markedly increased salivation. The pulse becomes rapid, run- 
ning, and feeble, the face deathly pale, total arrest of urinary secretion 
takes place through renal irritation, and death occurs by failure of respi- 
ration, which is accompanied by loss of all vital power. 

If the poisoning is not severe enough to cause death at once, a fatal 
result is, nevertheless, reached after a few days by reason of the severe 
gastro-enteritis and the widespread fatty degeneration of the tissues 
which iodine produces. 

The treatment of the poisoning consists in the use of large amounts of 
starch in any of its forms as the antidote, the employment of emetics 
and the stomach-pump, the application of heat to the body and extrem- 
ities, and, finally, the employment of hypodermic injections of alcohol, 
digitalis, and atropine or strychnine for the purpose of maintaining the 
strength of the circulatory and respiratory systems. 

Untoward Effects. — Under the name of "iodism" the profession 
recognizes a state of the body brought on by the prolonged and excessive 
use of iodine in any of its forms. The earliest notable signs of this 
state are a peculiar metallic taste in the mouth, particularly in the 
morning, slight tenderness of the teeth and gums, increase of salivary 
secretion, a little morning nausea, and a lack of appetite for breakfast, 
and perhaps some coryza or evidence of gastric irritation. Acne 
rosacea often comes on very early during the use of full doses of iodine. 
If the drug is continued, all these symptoms become more marked and 
the coryza becomes intense. Frontal headache and sore throat often 
appear, and the pustular and bleb-like changes in the skin go on to 
active suppuration. Sometimes large boils appear or purpura hemor- 
rhagica (iodic purpura) comes on. Slight catarrhal fever may develop. 

In other cases the nervous system chiefly suffers. Twitchings of 
muscles, neuralgic pains in the trunk and extremities, and wasting of 
the testicles, mammse, and all other tissues occur as the result of trophic 
disturbances. Anaemia amounting to an actual cachexia is commonly 
produced. Loss of vision and paralysis may ensue in extreme cases. 
Soullier asserts that albuminuria may be developed in children after 



284 DRUGS. 

tincture of iodine has been freely applied to the skin, by reason of its 
absorption and irritation of the kidneys. 

Therapeutics. — In all cases where the glandular system is in a state 
of chronic perverted functional activity, as in those diseases associated 
with disorder of the processes of nutrition, and often included under 
the single name of scrofulosis, iodine is of service. In enlargement of 
the lymph-glands it is, in its various forms, one of the best remedies we 
possess, but it ought not to be employed in those cases where rapid 
changes are going on in the gland, such as the formation of pus, since 
under these circumstances it will increase the size of the slough. 
Neither will it benefit the glanular enlargements of Hodgkin's diseased 
or lymphatic leukaemia, The drug ought never to be used in rapid 
phthisis, because it tends to disintegrate the tissues, and this is pre- 
cisely what the disease is doing. In the exceedingly chronic form of 
pulmonary disease known as fibroid phthisis iodine may often be used 
with advantage. When inhaled as vapor it may be of service as a 
stimulant to the mucous membranes, but is never of value in phthisis so 
far as combating the true pathological change is concerned. In coun- 
tries where goitre is very prevalent iodine ranks as a most efficient 
remedy, but it must be used with caution, and in case of exophthalmic 
goitre it is probably harmful in that the hypertrophied gland probably 
produces some of its symptoms by excreting too much iodine. In 
cystic or vascular enlargement of the thyroid gland it is valueless, but 
in simple overgrowth of the connective tissue of the gland iodine is of 
some value. Sometimes it is injected by means of a hypodermic needle 
into the gland. The usual dose is 10 to 15 minims (0.60-1.0) every 
second or third day till twenty or more injections have been used. 
Meltzer states that while this treatment is sometimes efficacious, it 
is not devoid of danger, for at least thirty deaths have resulted 
from it. 

In chronic bone disease iodine applied about the affected joint in the 
form of the ointment diluted one-half with lard, or in the pure tincture 
will be found of service, and if an&mia exists the syrup of the iodide of 
iron should be given internally. 

The other uses of iodine externally are many and important. As a 
slow counterirritant, which does not produce pain if properly employed, 
it is particularly useful in children, and may be employed in one to three 
coats, and no more, applied by means of a camel's-hair brush. 

The proper way to use the tincture of iodine as a local counter- 
irritant for adults is to give one good black coat at one sitting and not to 
repeat it until the skin has desquamated and become well renewed. If 
iodine is applied after desquamation of the skin has begun, it will cause 
agonizing burning pain, which nothing will relieve except the removal 
of the iodine by the use of cologne- water, alcohol, whiskey, or gin. 
The application of any of these liquids causes such an increase in the 
pain as to be almost useless after the skin is broken. The best solution 
for its removal is one of iodide of potassium, which should be followed 
by a starch poultice. A good rule to follow, is never to cause pain by 



IODINE. 285 

the use of iodine, as the drug acts equally well if applied in such a way 
as to avoid suffering. 

A stronger and more active preparation of iodine in solution for 
external use is that recently suggested by Elsberg. This preparation is 
of 20 per cent, strength, whereas the ordinary tincture is about 10 per 
cent. It is composed of iodine, 5 drachms (20.0) ; alcohol and ether, of 
each, 10 drachms (40.0). One or two coats of this solution painted 
upon the skin will produce as much effect as several of the ordinary 
tincture, and as it dries very rapidly it does not soil the clothing. 

Iodine in the form of the tincture is applied as a counterirritant 
paint to the skin of the chest in pleurisy, both to abort an attack and to 
aid in absorption of the fluid after it is passed out into the chest. In 
harassing, irritative cough it may be painted over the supraclavicular 
spaces, and it will sometimes lessen the secretion in chronic bronchitis 
if used in this way. In chronic rheumatism affecting the joints and 
muscles it does good when locally applied. Often in synovitis the local 
application of iodine causes increased swelling for some days. This 
should not cause alarm, for ultimately the swelling decreases greatly, 
and the cases in which this occurs are generally the best from a prog- 
nostic point of view. 

In the course of phthisis every now and then a "spot" in the chest 
will become "sore," probably due to a limited area of pleurisy, and 
under these circumstances tincture of iodine locally applied will give 
relief. In lupus the tincture may be painted around the edges of the 
growth, and even over its surface, with the object of retarding its 
spread. In chilblains an application of iodine ointment gives the 
greatest relief if diluted one-half with lard, and its use is probably the 
most efficacious measure at our disposal. In certain individuals who 
have "pains in the chest" iodine ointment may do good if rubbed in 
over the affected spot. As has been pointed out by others, iodine does 
good if muscular tenderness is present, while it fails if pleurodynia or 
intercostal neuralgia is the cause of the suffering. The latter troubles 
should be removed by the use of belladonna. In certain forms of skin 
diseases, such as tinea tonsurans and circinata, tincture of iodine may 
be applied with a camel's-hair brush, and even the entire scalp may be 
painted. A better way is to apply it to different spots each day. When 
erysipelas is present, the tincture may be painted around the edges of 
the inflamed area in order to prevent its spread. 

In old persons or those in middle life retraction of the gums from the 
teeth sometimes comes on, and dentists recommend for this disorder 
the use, by means of a earner s-hair brush, of a watery solution of 
iodine of the strength of 1 grain to the ounce (0.06-30.0), to be followed 
at once by a thorough rinsing of the mouth with pure water. In hydro- 
cele iodine in the form of the tincture is the best drug for effecting a 
permanent cure. The sac should first be emptied by the use of a trocar 
and canula, and the iodine alone or mixed with glycerin injected with 
a syringe, and then allowed to escape. As the pain produced by this 



286 DRUGS. 

injection is most atrocious, the patient should first be put under the 
influence of ether or other anaesthetic. 

Injections of iodine have been made into various serous cavities for 
the relief of chronic inflammatory processes. This is sometimes fol- 
lowed by unfavorable symptoms, and after the injection of tincture of 
iodine into the pleural cavity in hydrothorax symptoms of poisoning 
have come on in some cases, the most common complication being 
convulsions. These are epileptiform in character and are followed 
by coma or collapse. 

In empyema a solution of iodine 6 grains (0.40), iodide of potassium 
6 grains (0.40), and water 1 pint (480 c.c.) may be used daily as an 
irrigating fluid with good results; but this practice is not entirely 
devoid of danger, as too much of the iodine may be absorbed or the 
irritation produced in the chest by its injection may cause reflex and 
severe nervous symptoms. Iodoform is better. 

The tincture of iodine may be used, according to Ringer, as an 
inhalation with signal benefit in the following three instances : 

1. In the chronic forms of phthisis (fibroid lung). When the expec- 
toration is abundant and when the cough is troublesome, its inhalation, 
used both night and morning, will generally lessen expectoration and 
allay the cough. 

2. In children six to ten years of age, who after meals, or, independ- 
ently of them, on exposure to cold, are seized with hoarseness, a hoarse, 

hollow cough and some wheezing in the chest. This affection, involv- 
es © > 

mg the larynx, trachea, and larger bronchial tubes, and often proving 
very obstinate, is apt to return and to persist for some time. 

3. Some persons suffer with itching of the nose, of the inner canthus 
of one or both eyes, sneezing, running at the nose, of a watery fluid, 
weeping of the eyes, and severe frontal headaches; and these patients of 
various ages are greatly troubled, often for many years, with daily 
attacks of this character, lasting, it may be, several hours. Iodine 
inhaled often relieves this affection at once, ■ lessening the headache 
and discharge from the nostrils. Its effect is most marked in respect 
to the itching. 

Ringer generally adopts the following simple, handy, cleanly, and 
effectual plan of inhalation: Heat well a jug capable of holding' about 
2 pints, by rinsing with boiling water; then partly fill with boiling 
water, into which pour 20 to 30 minims (1.3-2.0) of the tincture 
of iodine; then direct the patient to put his face over the mouth of 
the jug and breathe the iodized steam, covering the head to prevent 
escape of the vapor. This inhalation should be used night and morn- 
ing for five minutes or a little longer. Occasionally an excess of iodine 
will temporarily produce a sensation of soreness in the chest and throat, 
accompanied with redness of the conjunctiva, running from the nose, 
and pain in the head. 

In some cases of acute coryza much relief may be obtained by sniffing 
the fumes of tincture of iodine from a bottle, as in the use of "smell- 



IODOFORM. 287 

log salts." The heat of the hand is sufficient to disengage the vapor 
in proper quantity. 

Administration. — Iodine is never used in solid form, and it has 
been taught that the tincture (Tinctura Iodi, U. S. and B. P.) should 
not be given internally, on the ground that it is precipitated in the 
stomach. Whether this be true or false, it is a fact that the tincture 
has been largely used in the vomiting of pregnancy and that occurring 
after the use of anaesthetics with very good results. The dose is 5 to 10 
minims (0.30-0.60), well diluted. Under the name of Lugol's solution 
(Liquor Iodi Compositus, U. S.) iodine is frequently used internally; 
the dose is 5 to 10 minims (0.30-0.60), in water. Liquor Iodi Fortis, 
B. P., is used as a liniment or local application. 

Unguentum Iodi, U. S. and B. P., is used locally over enlarged glands. 
In the case of children or adults who have delicate skins the ointment 
should be diluted one-half with lard. This ointment should always be 
freshly made. 

Contraindications. — Iodine is contraindicated in renal diseases, 
except in small doses, during the progress of acute inflammation, and 
whenever tissues are rapidly undergoing a breaking-down process. 



IODOFORM. 

Iodoform (Jodoformum, U. S. and B. P.) occurs in small saffron- 
colored crystals which possess a characteristic, penetrating odor and 
strong taste. It is soluble in alcohol, ether, chloroform, benzol, and 
in fixed and volatile oils, but is insoluble in water. 

Physiological Action. — The effects of iodoform upon the circulation, 
respiration, and other vital functions are very slight when the drug is 
used as a surgical dressing in ordinarv amounts or when it is given bv 
the mouth. in average doses. It acts as an anaesthetic upon mucous 
membranes, and produces those changes which we are wont, for want 
of a better term, to call ''alterative," in the tissues with which it comes 
in contact. Iodoform is eliminated in the urine as iodine or as alkaline 
iodides, chiefly iodide of sodium. The drug also escapes by the saliva 
as an alkaline iodide. 

Poisoning. — If applied to an absorbing surface in susceptible indi- 
viduals, iodoform may cause general systemic poisoning. This poison- 
ing may be mild, in which case there is a general feeling of malaise, 
with nausea and the perception of various odors which are in reality not 
present. There may be headache and vomiting. If the system is still 
more impressed by the drug, these symptoms are followed by cerebral 
excitement, insomnia, loss of memory, loss of appetite, and a rapid 
pulse. In grave cases convulsive movements and maniacal delirium, 
alternating with coma, may be the dominant symptoms. The pulse 
is small and rapid, and there is often retention of urine or hematuria. 
Loebisch asserts that the mental excitement cannot be quieted by 
narcotics. If death occurs, the heart and respiration fail simultane- 



288 DRUGS. 

ously. In addition to the fatty degeneration which such poisoning pro- 
duces in all the vital organs, there is sometimes found an cedematous 
condition of the pia mater or a low-grade leptomeningitis. These 
symptoms seem to occur more commonly in the aged. In the graver 
cases the onset of the poisoning is apt to be sudden, though from 
twenty-four hours to several days usually elapse between the applica- 
tion of the drug and the onset of the symptoms of poisoning. 

Treatment of the poisoning by iodoform consists, according to 
Soullier, in the administration of bicarbonate of sodium to unite with 
the iodine and so aid in its elimination; the use of alcoholic stimulants 
to support the system; the employment of diuretics, and wrapping the 
patient in hot blankets to encourage free sweating, so relieving the 
kidneys. Kocher advises saline transfusion in such cases. 

Untoward Effects. — It is not to be forgotten that iodoform when 
applied as a dressing may produce less violent symptoms than those 
just described, and capable, because of their aberrant character, of 
seriously misleading the physician. Thus a scarlatinal rash may 
develop with fever, malaise, and nervous disturbances. 

Therapeutics. — Iodoform is used chiefly as a surgical dressing, but 
is by no means so popular for this purpose as it was at one time. It is 
antiseptic, but not germicidal. Germs may be found in powdered 
iodoform, and will even grow in it. When used locally, the drug does 
good by absorbing the liquids of the wound, and thereby removing the 
nidus for germ-growth, and when applied to large moist surfaces gives 
off free iodine and acts as well as a protective. There can be no doubt 
that iodoform when applied to a wound does good, not by destroying 
the bacteria directly or indirectly, but by inducing chemical changes 
in their toxins. 

In syphilitic sores the following dressing will be found of great 
service: iodoform, 20 grains (1.3); oil of eucalyptus, | fluidounce 
(16.0); or a powder of iodoform \ ounce (16.0), camphor 75 grains 
(5.0), and essence of roses 2 drops (0.1), may be employed. In eczema, 
with tingling and itching, the following application will give relief 
(Ringer) : 

1$ — Iodoformi gr. iv (0.25) 

Olei eucalypti . f5j (4.0). 

Petrolati §j (30.0).— M. 

S. — Apply locally. 

Internally, iodoform is used in tertiary syphilis in all its forms in the 
dose of from 1 to 5 grains (0.06-0.30). Bartholow has recommended 
it most highly in catarrhal jaundice and in the early stages of hepatic 
cirrhosis. 

The influence of iodoform upon the tubercle bacillus is very great, 
and it is largely used in the treatment of tubercular disease of the 
joints and pleura. The pus is allowed to escape under antiseptic pre- 
cautions; the cavity is washed out with warm boric-acid or carbolic-acid 
solutions of low strength, and from 1 to 6 drachms (4.0-24.0) of an 



IODOL. 289 

emulsion of iodoform and sterilized sweet oil are injected and allowed 
to remain. The strength of the iodoform-and-oil emulsion should 
usually be 10 per cent. Should the abscess cavity fail to heal after 
these injections have been repeated every few days for some time, it 
must be reopened, scraped, and injected again or packed with iodoform 
gauze. The iodoform also promotes healing through its alterative 
influence, which aids in the absorption of the inflammatory exudate. 
Should tubercular glands be present, injections may be made into them 
even if pus has not formed. 

Used by means of a powder-blower, iodoform will often relieve the 
hoarseness and discomfort of laryngeal phthisis, but it must be pulver- 
ized most minutely. Sometimes a spray may be used, which should 
consist of spirit of turpentine and sweet oil, half-and-half, and con- 
tain 2 grains (0.12) of iodoform to each ounce (30.0). This mixture 
may also be used in chronic bronchial catarrh to lessen the cough and 
fetid discharge. In the early stages of phthisis several clinicians claim 
to have obtained good results by the daily hypodermic injection into 
the back of 30 minims (2.0) of a 1 : 100 solution of iodoform in oil of 
sweet almonds, but this treatment has not found favor, in the United 
States at least. 

For fissure of the anus and irritated hemorrhoids 5 grains (0.30) of 
iodoform in a suppository may be placed in the rectum, and after it 
has remained there a few minutes defecation may take place with little 
or no pain. The pain following operations on the female perineum 
may also be much relieved in this manner. In the tenesmus of cholera 
infantum an injection of 1 ounce (30.0) of sweet oil with 5 grains (0.30) 
of iodoform will give great relief if used after or before enterocylsis. 

Administration. — The ointment of iodoform (Unguentum Iodoformi, 
U. S. and B. P.) is useful when applied over fetid sores. It should 
always be freshly made. The drug itself may be given in 1- to 5-grain 
(0.06-0.30) doses three times a day. The suppositories (Suppositoria 
Iodoformi) are official in the B. P.; each one contains 3 grains (0.20) 
of iodoform. (See also Nosophen, Europhen, and AristoL) 



IODOL. 

Iodol is a dark, dirty-yellowish-looking powder, soluble in alcohol, 
ether, and oils, but only slightly so in water. It should be kept in 
amber-colored bottles. Its uses in medicine are identical with those of 
iodoform, and it possesses the advantage of having a less penetrating 
odor than the latter drug. 

In tubercular laryngitis the very finely powdered drug may be blown 
into the larynx without disagreeable results and with a favorable effect 
on the disease process. Cerna has found iodol of great service in 
diabetes when given internally in the dose of from 2 to 6 grains (0.12- 
0.40) three times a day, and it is said to be of value in tertiary 
syphilis in the same quantity. 

19 



290 



DRUGS. 



A useful antiseptic dressing for small wounds and abrasions is 
made by adding 1 part of iodol to 10 parts of ether and 5 of gun-cotton, 
thereby preparing an iodol collodion. 

Ingalls recommends the following prescription in cases of eczema or 
abrasions of the upper lip and nostrils : 

1$ — Acid, carbolic. . . v\x (0.3). 

01. rosse tt\v (0.3). 

Iodol gr. xxv (1.6). 

Lanolin |ss (16.0).— M. 



IPECACUANHA. 

Ipecacuanha, U. S., or Ipecacuanha? Radix, B. P., or Ipecac, is the 
root of Cephaelis Ipecacuanha (Psychotria Ipecacuanha, B. P.), a 
small shrub of Brazil. It contains an alkaloid, emetine, and ipecac- 
uanhic acid. 

Physiological Action. — Locally applied to mucous membranes, ipe- 
cac acts as an irritant, and if applied for a long period to the skin pro- 
duces vesicles and irritation. 
Fig. 48. Very minute doses have little 

noticeable effect, but large ones 
produce nausea, relaxation, vom- 
iting, free secretion into the bron- 
chial tubes, and a profuse flow of 
saliva. The emesis is due both 
to the irritation of the stomach 
and to an effect upon the vomit- 
ing centre in the medulla (Fig. 
48). The drug acts as a depress- 
ant to the spinal cord (Pecholier), 
and it also depresses the heart if 
given in large doses and retained 
by the stomach long enough for 
it to be absorbed. Ipecac is 
eliminated by the kidneys, the 
gastro-intestinal mucous mem- 
brane, and the skin (Binz). 
If emetine is given in lethal 
dose to one of the lower animals, death is due to failure of respiration. 
Therapeutics. — Ipecac is used as an emetic where a fairly rapid 
action is required. It is particularly useful where the stomach of a 
child is overloaded with food. In cases of poisoning it is hardly 
active or rapid enough as an emetic, and is not so good as mustard or 
sulphate of zinc. In babies and young children an attack of bronchitis 
often causes digestive disorders by reason of the mucus coughed up 
from the lungs being at once swallowed instead of spat out of the mouth. 
In these cases the stomach may be relieved and the state of the lungs 
improved by the use of an emetic dose of syrup of ipecac, 2 to 3 drachms 




A, vomiting centre in the medulla stimulated 
by ipecac; B, nerves in mucous membrane of 
stomach irritated by ipecac. 






IPECACUANHA. 291 

(8.0-12.0). Often if the dose be not large enough to produce emesis it 
will purge the child and remove the mucus by the bowel. 

In some cases of obstinate vomiting small doses of ipecac will act as 
a most successful cure, provided that the vomiting is due not to inflam- 
mation and excitement, but to depression. The irritant effect of the 
ipecac stimulates the depressed stomach to a normal tone. The proper 
dose of ipecac for this purpose is J to \ grain (0.008-0.015) or less 
every half-hour until five or six doses are taken. 

In some cases of the vomiting of pregnancy it is very useful, in others 
it utterly fails. 1 minim (0.06) of the wine or J to J grain (C. 008-0. 015) 
of the powdered ipecac, repeated every half-hour for six o; seven doses, 
is all that should be used. In the morning vomiting of drunkards 
ipecac is of service, but it is not so good a remedy as are small amounts 
of arsenic or hydrochloric acid. 

Ipecac is also said to possess marked oxytocic properties, similar to 
quinine, when given in small doses, 10 to 15 minims (0.60-1.0), of the 
wine every two or three hours. 

In true acute dysentery ipecac is one of the best remedies we possess. 
When the passages are large and bloody and the disease is malignant, 
as it occurs in the tropics, ipecac should be given in the following man- 
ner: The powdered ipecac is to be administered on an empty stomach 
in the dose of 30 grains (2.0) with 30 minims (2.0) of deodorized 
laudanum, which is used to decrease the tendency to vomit. Absolute 
rest is essential for success. Finally a profuse gray, mushy stool is 
passed. The passage of this stool is a most favorable prognostic sign, 
and its non-appearance is equally significant of failure. There are 
a decrease in pain and a lessening of the fever and of the bloody dis- 
charges. Woodhull, of the U. S. Army, states that retching, vomiting, 
delirium, and exhaustion do not contraindicate this plan of treatment, 
but that it is useful when these symptoms complicate this disease. If 
the first dose is rejected, it may be repeated in a few hours, preceding 
it by the laudanum. Counterirritation is to be applied to the belly, 
and stimulants freely used to avoid great depression. 

In choleraic diarrhoeas and cholera morbus ipecac is said to be of 
service in the dose of 3 grains (0.20) every two hours if opium is given 
to control nausea. 

No less a person than Trousseau asserted that ipecac was a haemo- 
static, and it is said to be a most effective remedy in small doses in 
haemoptysis, and in all hemorrhages which are capillary in character. 

Ipecac may be used in the early stages of bronchitis, to act as a seda- 
tive to the inflamed mucous membrane and to promote secretion. 
Under these circumstances it is best combined with citrate of potas- 
sium. (See Bronchitis.) 

Ringer and Murrell have found that inhaling ipecac spray is very 
useful in chronic winter cough or bronchitis, particularly when there is 
present shortness of breath. The pure wine may be used in a spray 
apparatus or be diluted one-half with water. While the throat may 



292 DRUGS. 

seem temporarily worse, the shortness of breath rapidly decreases and 
marked improvement takes place in the cough. In order to prevent 
the wine which collects in the mouth from being swallowed, and 
nausea and vomiting thereby induced, the patient should be directed 
to rinse his mouth thoroughly every few minutes. The inhalation 
should not last at first over three or four minutes, and, until it is known 
how well the patient will bear the application, the wine should be 
diluted twice or thrice with water and alcohol, equal parts. 

It is stated that powdered ipecac made into a paste and smeared on 
the skin will greatly relieve the pain and swelling produced by the 
stings of bees. 

Administration. — The syrup (Syrupus Ipecacuanha?, U. S.) is given 
in the dose of \ to 1 drachm (2.0-4.0) as an expectorant, or in the same 
dose as an emetic to an infant. The wine (Vinum Ipecacuanhce, U. S. 
and B. P.) is given in the same dose as the syrup and the fluid extract 
(Fluidextractum Ipecacuanha?, U. S. ; Extractum Ipecacuanha? Liquidum, 
B. P.) in the dose of 30 minims (2.0) as an emetic to an adult. The 
troches (Trochisci Ipecacuanha?, B. P.) contain \ grain (0.015) each. 
Trochisci Morphine ei Ipecacuanha?, B. P., each of which contains 
3 X g- grain (0.002) of morphine and y 1 ^ grain (0.005) of ipecac, are used 
in sore throat, dissolved in the mouth. Dover's powder (Pulvis 
Ipecacuanha? et Opii, U. S.; Pulvis Ipecacuanha? Compos ita?, B. P.) 
is given in the dose of 5 to 15 grains (0.30-1.0). It contains 1 part 
(0.06) of opium, 1 part (0.06) of ipecac, and 8 parts (0.5) of sugar of 
milk. (See Opium.) 

Emetine may be given in the dose of -^ to \ grain (0.005-0.01) as 
an emetic, but is very rarely so employed. 

The additional British preparations are the pill of ipecac and squill 
(Pilula Ipecacuanha? cum Scilla, B. P.), given in the dose of 5 to 10 
grains (0.35-0.65), and the vinegar of ipecac (Acetum Ipecacuanha?, 
B. P.), given in the dose of 5 to 30 minims (0.3-2.6), which are used 
as expectorants. 

IRON. 

Iron (Ferrum, U. S. and B. P.) is a metal which is used both as a 
medicine and a food — a food because it forms part of the body when 
taken into the organism and is used by the system in the making of 
blood. The number of its official salts and compounds is far in excess 
of the needs of practical physicians, and half the preparations are 
rarely, if ever, used, 

Physiological Action. — Iron has little or no effect upon the system 
when given in a single dose, but repeated doses cause an increase in 
the number of red blood-corpuscles, and plethora, or an increase in 
the quantity and quality of the blood. Much discussion has arisen as 
to whether iron is absorbed when given as a drug in the form of one of 
the inorganic salts. One theory has been that only the organic iron of 






IRON. 293 

the food is absorbed, and that metallic iron when given freely allows 
this absorption to go on both by stimulating the bowel and by entering 
into combination with the sulphuretted hydrogen in the intestine, 
thus permitting the organic iron to escape into the system. That both 
forms of iron are absorbed and eliminated is now certain. (For a 
discussion of some of these views see article on Anaemia.) If, however, 
iron is given in excessive doses, much of it remains unabsorbed, is 
changed into the sulphide of iron in the bowels, and escapes with the 
feces. Careful studies have shown that the iron, when once absorbed, 
escapes from the body very slowly, and that its pathway of escape is 
not by the bile or in the urine, but by the walls of the intestine which 
excrete it, so that it may be recovered from the feces. It has been 
asserted that it is never released from the body, but this is untrue. 
Whether it acts as a stimulant to blood-manufacture or simply supplies 
the glands with blood-making material is not known, but the latter 
is probably the correct view. Iron causes oxidation to go on more 
rapidly by reason of its peculiar power of converting oxygen into ozone, 
and in this manner acts as a stimulant to nutrition and bodily activity. 

The preparations of iron consist in the soluble and insoluble salts or 
forms. Of these the insoluble are better than the soluble, because 
nearly all the soluble salts of iron are precipitated by the gastric juice 
and have to be slowly redissolved. Nearly all iron preparations are 
capable of acting as more or less powerful astringents, and so are apt 
to cause constipation and to disorder digestion if given in large doses. 
The most astringent of all these preparations are Monsel's salt (the 
Ferri Subsulphas, U. S., B. P.) and the sulphate (Ferri Sulphas, U. S. 
and B. P.). Closely following these in astringency are the ammonio- 
ferric alum (Ferri et Ammonii Sulphas, U. S.) and the chloride of iron 
(Ferri Chloridum, U. S.). The least astringent preparations are 
Quevenne's iron, or iron by hydrogen (Ferrum Reductum, U. S. and 
B. P.), carbonate of iron (Ferri Carbonas Saccharaius, U. S. and 
B. P.), Basham's Mixture (Liquor Ferri et Ammonii Acetatis, U. S.), 
the citrates, tartrates, and the lactate and phosphate of iron. 

Therapeutics. — The chief indications for the administration of iron 
are those forms of anaemia (see Anaemia) characterized by a decrease 
in the normal quantity of haemoglobin in the blood as determined by the 
haemoglobinometer, as, for example, chlorosis. Its chief contraindica- 
tion is plethora. When used in small dose (\ to \ grain — 0.015-0.03) 
it is quite as efficacious as in large amounts, and less apt to disorder the 
stomach, but the doses given in this article are the classical ones usually 
prescribed by physicians. In some cases of anaemia of a semi-pernicious 
type large doses of iron are really needed, probably because the system 
is deranged in such a manner that an excessive loss or elimination of 
iron is constantly present. Large doses compensate for this leakage 
and afford the quantity needed for physiological purposes. Iron should 
not be used as a tonic unless some direct indication for its employment 
is present, and no drug is more abused in this respect than iron. As 



294 DRUGS. 

every preparation possesses some peculiarity, the use of each will be 
considered separately. 

Ammonio-ferric Alum. 

Ammonio-ferric Alum (Ferri et Ammonii Sulphas, U. S.) is often 
given in cases of atonic leucorrhaa associated with chlorotic tendencies 
in the dose of 2 to 5 grains (0.12-0.30). It is quite astringent, and 
should not be given in cases of gastric irritability, as it is not suited to 
such a condition. 

Aromatic Mixture of Iron. 

The Aromatic Mixture of Iron (Mistura Ferri Aromatica) contains 
so little iron that it should not be administered in cases where a very 
marked chalybeate influence is desired; it is, however, a useful tonic 
for cases of debility and slight anaemia following long illnesses, given 
in the dose of 1 to 2 fluidounces (30.0-60.0) after meals. Aromatic 
mixture of iron contains cinchona-bark, calumba, cloves, iron, com- 
pound tincture of cardamoms, tincture of orange-peel, and pepper- 
mint-water. 

Arsenate of Iron. 

Arsenate of Iron (Ferri Arsenas, B. P.) is used in the dose of yg to y 1 ^- 
grain in anaemic subjects who are suffering from the dry, scaly forms of 
skin disease which indicate the use of arsenic. (See Arsenic.) It is also 
of value in the anaemia of chronic diarrhoea, as both iron and arsenic 
are useful, not only for the anaemia, but for the control of the intestinal 
disorder. 

Basham's Mixture. 

Under the name of Basham's Mixture (Liquor Ferri et Ammonii 
Acetatis,\J. S.) a very useful and elegant preparation of iron is employed. 
It is particularly useful in the ancemia of acute and chronic parenchy- 
matous nephritis, as it also acts as an efficient diuretic and diaphoretic. 
It is made up as follows: 

Tincture of chloride of iron .... 4 parts. 

Dilute acetic acid 6 

Spirit of mindererus 40 

Elixir of orange 10 

Glvcerin 15 

Water 25 " 

The dose is from 1 to 4 drachms (4.0-16.0), well diluted. 

Bromide of Iron. 

Bromide of iron (Ferri Bromidum) is said to be useful in ancemia, 
when this state is associated with chorea, in the dose of 5 to 20 grains 
(0.30-1. 3)'given in syrup. In other nervous diseases accompanied by 
anaemia and insomnia the syrup of the bromide of iron (Syrupus 



IRON. 295 

Ferri Bromidi) is useful in the dose of J to 1 fluidrachm (2.0-4.0), 
but its sedative properties are not sufficiently marked to render it of 
much value in overcoming true insomnia unless it is fortified by one of 
the other bromides. 

Cacodylate of Iron. 

Under the name of cacodylate of iron a compound has been intro- 
duced which is given in cases of anamiia, in which the haemoglobin and 
the corpuscles are lacking, since by this means we obtain the effect of 
both iron and arsenic. The salt may be given by the mouth in the dose 
of \ to 1 grain (0.015-0.06) three times a day, in solution, or in urgent 
cases in the dose of J to \ grain (0.008-0.015) by the hypodermic needle 
three times a day. It is asserted by Gilbert and Tereboullet that this 
is not productive of local or renal irritation, and in the albuminuria of 
tuberculosis may even be beneficial. Arsenate of iron is more useful. 

Carbonate of Iron. 

The Carbonate of Iron (Ferri Carbonas Saccharatus, U. S. and 
B. P.) is very slightly astringent, and may be used in pill form under 
the name of Piluloe Ferri Carbonatis, U. S. (Pilidce Ferri, B. P.), 
sometimes called "Blaud's pill," or in Griffith's pill, which also con- 
tains myrrh. The dose is about 3 grains (0.20). This preparation of 
iron is largely used for the treatment of amenorrhcea dependent upon 
anaemia. Under the name of Mistura Ferri Composita, U. S. and 
B. P., or Griffith's mixture, a liquid preparation is used for the same 
purposes as the pills just named, in the dose of 1 to 2 tablespoon- 
fuls (15.0-30.0). Massa Ferri Carbonatis, U. S., sometimes called 
Vallet's mass, is given in pill in the dose of from 1 to 10 grains (0.06- 
0.60). 

Chloride of Iron. 

Tincture of the Chloride of Iron (Tinctura Ferri Chloridi, U. S.; 
Tinctura Ferri Perchloridi, B. P.), often called Tincture of the Muriate 
of Iron, is one of the best and most useful preparations of iron. It is 
the most diuretic preparation of iron. This diuretic effect does not 
depend upon the presence of muriatic ether, as has been taught, since 
it is not present, and is difficult to prepare except there is an excess of 
chlorine. According to researches of Dr. S. Weir Mitchell the only ether 
present is nitrous ether, and this is devoid of power and in small 
quantity. As chloride of iron itself is diuretic, it is probably upon 
this that the diuresis produced by it depends. The dose of the 
chloride of iron (Ferri Chloridum, U. S.) is 1 to 3 grains (0.06-0.20). 
Tincture of the chloride of iron is considered a specific in erysipelas, 
and should be given in full dose and frequently repeated if it is to 
be of any service. (See Erysipelas.) 10 minims (0.60), well diluted, 
every hour are not too much if the stomach of the patient does not rebel. 
In chronic Briqhfs disease it is of value and decreases the albuminuria. 



296 DBUGS. 

In ancemia it is useful, and owing to its acid content is a doubly effective 
tonic. In cases of slight ansemia in which high arterial pressure exists 
Dr. Mitchell uses a purely milk diet, and an ounce of an old tincture of 
iron in the twenty-four hours. While he recognizes the fact that iron 
preparations are generally supposed to raise blood-pressure, he asserts 
that in this instance the blood-pressure is lowered. The dose of Liquor 
Ferri Chloridi, U. S., is 4 to 10 minims (0.25-0.60). It is rarely used 
internally, but chiefly as a powerful local astringent. Liquor Ferri 
Chloridi is identical with Liquor Ferri Perchloridi, B. P. Tinctura 
Ferri Perchloridi, B. P., is used internally in the dose of 10 to 20 
minims (0.60-1.3). 

As a local application tincture of the chloride of iron is useful in 
diphtheria and membranous croup, and even in tonsillitis. In each of 
these maladies large doses of the tincture internally, with counter- 
irritation over the neck, are most useful. When used internally it 
should be well diluted with water and taken through a glass tube, to 
protect the teeth. The strong solution of perchloride of iron (Liquor 
Ferri Perchloridi Fortis, B. P.) is a powerful styptic. 

Citrates and Tartrates of Iron. 

The four citrates of iron are soluble in water and very useful for this 
reason because they are readily added to liquid prescriptions, and 
they are also of value because they are slightly irritant and astringent 
and do not disorder the alimentary canal. Ferri Citras, U. S., and 
Ferri et Ammonii Citras, U. S. and B. P., occur in garnet-red scales, 
and are given in the dose of 5 grains (0.30). The solution of the 
citrate of iron (Liquor Ferri Citratis) is given in the dose of 10 minims 
(0.60). The Ferri et Quinine Citras, B. P., and the Ferri et Strychnine 
Citras, U. S., are usually given in the dose of 5 to 15 grains (0.30-1.0) 
and 1 to 3 grains (0.06-0.20), respectively. The new official Ferri et 
Quinine Citras Solubilis,\J. S., is given in the dose of 1 to 2 grains 
(0.06-0.12). 

Besides these citrates there are three tartrates — Ferri et Ammonii 
Tartras, U. S., and Ferri et Potassii Tartras, U. S., and Ferrum Tar- 
taratum, B. P., all given in the dose of 5 grains (0.30). 

Dialyzed Iron. 

Dialyzed iron (Ferrum Dialysatum) is a very feeble preparation of 
iron, lacking in astringency, easily precipitated from the solution in 
which it occurs, but at one time largely used in anemia by some prac- 
titioners. The dose is 10 to 20 minims (0.30-1.3) in water three times a 
day. Sometimes river-water, if it contains much inorganic or organic 
matter, will precipitate it. Owing to the instability of dialyzed 
iron, it may be used as an antidote to arsenic without further 
preparation. 



1B0N. 297 

Hydrated Sesquioxide of Iron. 

Hydrated Sesquioxide of" Iron (Ferri Hydroxidum, U. S.) is the 
antidote to arsenic, but to be efficacious it must be freshly prepared. 
It is to be made by precipitating any liquid preparation of iron by the 
addition of an alkali, such as ammonia, or by the addition of magnesia. 
The resulting precipitate is the antidote, and the supernatant liquid is 
to be poured off. If ammonia is used, the precipitate must be washed 
with water several times to get rid of the alkali, which will render the 
antidote too irritant to be swallowed if it is allowed to remain with the 
precipitate. Magnesia is an antidote in itself, and should be preferred 
under all circumstances. The antidote should be given in excess, and 
as much as a pint of the iron solution should be precipitated. The 
magnesia should be freely added, as too much of it cannot be given. 
The antidote to arsenic is official as Ferri Hydroxidum cum Mag- 
nesia, U. S. In the Prussian Pharmacopoeia this is known as the 
Antidotum Arsenici. (See Arsenic, Poisoning by, for official method of 
preparing antidote.) 

Iodide of Iron. 

The Syrup of the Iodide of Iron (Syrupus Ferri lodidi, U. S. and 
B. P.) is a transparent liquid of a sweet, iron-like taste. It should con- 
tain no free iodine, and if a sample of it strikes a blue color with starch 
it should be discarded. It is largely used in anosmia associated with 
scrojulosis and struma, and is useful in the eczema of young children 
when this is dependent upon lack of vitality or anaemia. The dose to a 
child of two years is 3 to 6 minims (0.20-0.40), well diluted, and to an 
adult 30 to 40 minims (2.0-2.6) in water, to be taken through a glass 
tube to protect the teeth. 

The saccharated iodide of iron (Ferri Iodidum Saccharaium) is 
used in place of the syrup in the dose of 2 to 5 grains (0.12-0.3). The 
official pills (PiluloB Ferri lodidi, U. S.) each contain \ grain (0.01) of 
reduced iron and \ grain 0.008) of iodide, and are given in the dose 
of one to three pills. 

Subsulphate of Iron, or MonseFs Salt. 

Monsel's Solution (Liquor Ferri Subsulphatis, U. S.; Liquor Ferri 
Persulphatis, B. P.) is sometimes wrongly called the solution of the 
Persulphate of Iron, and is one of the most powerful styptics or haemo- 
statics that we have. It is never to be employed where a hemorrhage 
is to be controlled through the circulation, but only when the solution 
can come in direct contact with the bleeding spot. The objection to its 
use is the hard, black, and dirty clot which it forms on coming in con- 
tact with blood. In haemoptysis Monsel's solution may be used in fine 
spray consisting of from 10 to 60 minims (0.60-4.0) to the- ounce (30.0) 
of distilled water. In uterine hemorrhage from any cause the dilution 



298 DRUGS. 

may be half-and-half, or if the hemorrhage be from a polypus or the 
cervix uteri the pure solution should be used, locally applied. In nose- 
bleed Monsel's solution may be employed diluted one-half or pure; but 
its use is not to be commended, because of the hard, black clot which is 
formed and the uncomfortable sensations and pain produced in the 
nasal chambers. Plugging the nostrils, and if need be the posterior 
nares, with pledgets of cotton is generally sufficiently efficacious. 

For the intestinal hemorrhage occurring during or after typhoid fever 
Monsel's solution has been given, but ought not to be so employed, as 
it is decomposed in the stomach before it reaches the intestine. In its 
stead Monsel's salt (Ferri Subsulphas) should be given in pills of 3 
grains (0.20) each, the pills being made hard enough to escape into the 
intestine before the stomach dissolves them. One, two, or three pills 
may be given, and repeated in an hour in pressing cases. Hamiatemesis 
due to bleeding in the stomach may be treated by 3-minim (0.20) doses 
of the solution in a little water. It should be remembered, however, 
that the drug is irritating if frequently repeated. 

In tonsillitis and pharyngitis a most efficient application is pure 
Monsel's solution applied by means of a pledget of cotton or camel's- 
hair brush, or equal parts of the solution and glycerin may be used. 
This application is often as painful as it is efficient, and care must be 
exercised that an excess of the fluid be not present, as it may drop into 
and irritate the larynx. In diphtheria this method of treatment may 
be used if peroxide of hydrogen cannot be obtained. 

The antidote to Monsel's solution is common soap. 

Oxalate of Iron. 

Oxalate of Iron (Ferri Oxalas) is given in the dose of 2 to 3 grains 
(0.12-0.20). It possesses no advantages peculiar to itself. 

Phosphates of Iron. 

There are two phosphates of iron — Ferri Phosphas Solubilis, U. S., 
or Ferri Phosphas, B. P., and Ferri Pyrophosphas Solubilis, U. S., 
Phosphate of iron itself is insoluble and is rarely used. The official 
forms are, however, quite soluble, and useful in the dose of 2 to 5 
grains (0.12-0.30). Syrupus Ferri Phosphatis, B. P., is given in the 
dose of 1 fluidrachm (4.0). Phosphate of iron is one of the ingredients 
of the syrup of iron, quinine, and strychnine (Syrupus Ferri, Quinine- 
et Strychnine Phosphatum, U. S.; Syrupus Ferri Phosphatis cum 
Quinina et Strychnina, B. P.), which is given in the dose of 1 fluidrachm 
(4.0), and of the elixir of iron, quinine, and strychnine (Elixir Ferri, 
Quinine et Strychnine Phosphatum, U. S.), given in the same dose 
as the syrup. 

Reduced Iron. 

Quevenne's Iron (Ferrum Reductum, U. S., Ferri Redactum, B. P.) 
is an iron-gray or reddish powder which is frequently adulterated 
with lampblack. If it is pure, it should burn in sparks when dropped 



IRON. 299 

into a flame; but if lampblack is present this will not occur. It should 
also yield no sulphuretted hydrogen on adding sulphuric acid to it. It 
is tasteless, and may be given to children for this reason in pills or 
gum-drops, or placed inside of small chocolate creams, or in the form 
of troches (Trochisci Ferri Redacti, B. P.), each lozenge containing 

1 grain (0.06) of the reduced iron. It is used solely in ancemia, and is 
one of the least astringent of the iron preparations. Dose y^- to 2 
grains (0.006-0.12). 

Lactate of Iron. 

The Lactate of Iron (Ferri Lactas) is soluble in 48 parts of water, 
and is given in the dose of 5 grains (0.30). It is used for the same 
purposes as the other preparations of iron. Lactate of iron is one of 
the ingredients of the formerly official Syrupus Hypophosphitum cum 
Ferro, the dose of which is \ to 1 fluidrachm (2.0-4.0). 

Sulphate of Iron. 

Sulphate of Iron (Ferri Sulphas, U. S. and B. P.) is used internally 
in the dose of 5 grains (0.30) in pill form in chronic diarrhoea with 
an&mia. Externally, in a solution of the strength of 5 to 25 grains to 
the ounce (0.30-1.6:30.0), it is used as an astringent lotion. Two 
other forms of the sulphate are also employed — namely, the dried 
Ferri Sulphas Exsiccatus, U. S and B. P.) and the granulated (Ferri 
Sulphas Granulatus, U. S.), each of which is given in the dose of 3 
grains (0.20). 

Valerianate of Iron. 

Valerianate of iron (Ferri Valeras) is sometimes used in hysteria 
with an&mia, given in the dose of 1 grain (0.06) or more. It possesses 
a very feeble influence as a nervous sedative. 

Wines of Iron. 

The Bitter Wine of Iron (Vinum Ferri Amarum, U. S.) is useful as a 
bitter tonic in anaemia in both children and adults, and may be advan- 
tageously accompanied with cod-liver oil. It is given in the dose of 1 to 

2 fluidrachms (4.0-8.0) or more. This wine is composed of soluble 
citrate of iron and quinine, tincture of sweet orange-peel, syrup, and 
stronger white wine. 

Wine of the Citrate of Iron, or Vinum Ferri, U. S.; Vinum Ferri 
Citratis, B. P., is composed of the citrate of iron and ammonium, 
tincture of sweet orange-peel, syrup, and stronger white wine. The 
dose is identical with that of the bitter wine, and it is used for the 
same purposes. 

The plaster of iron (Emplastrum Ferri) is prepared from the 
hydrated oxide of iron. 

The Liquor Ferri Acetatis, B. P., is given in the dose 15 minims to 
1 fluidrachm (1.0-4.0). 



300 DRUGS. 

Untoward Effects of Iron. — Iron is apt to cause gastric distress and 
frontal headache in persons who are susceptible to its use. Even one 
dose will cause this trouble in some patients. In many instances the 
frontal headache will be found to be due to the constipation which has 
been brought on by the iron, and will be relieved if mild laxatives or 
purges are used. The state of the bowels should always be inquired 
into when iron is being used, and laxatives given whenever constipation 
is present. In rheumatic and gouty persons frontal headaches are a 
common symptom when iron is given, and purgatives will not generally 
give relief. Garrod and Haig have shown that iron decreases the 
elimination of uric acid, and they think this may account for the pro- 
duction of headache in the case of rheumatic patients under its 
influence. Sometimes salts of iron produce vesical irritation and a 
constant desire to urinate, causing mucus to form in abnormal amount 
in the bladder. In children its use may result in nocturnal incontinence 
of urine. 

JALAP. 

Jalap {Jalapa, U. S. and B. P.) is the tuberous root of Exogonium 
Purga (Ipomoea Purga, B. P.), a native of Mexico. It contains two 
resins, jalapin and convolvulin, neither of which is used in medicine 
by itself, though both of them enter into the Resin of Jalap of the 
U. S. P. 

The term jalapin is sometimes employed to designate the resin. 
In overdose jalap or its resin causes vomiting and purging, with 
gastro-enteritis. 

Therapeutics. — Jalap is used in medicine as a hydragogue purge to 
relieve dropsy of any origin. It may be used to deplete in cases of 
general plethora with cerebral congestion, and owing to its tastelessness 
is a useful active cathartic in children if given in the proper dose — ■ 
namely, 1 to 2 grains (0.06-0.12) in \ ounce (16.0) of syrup of 
rhubarb. Combined with calomel, it is preferred to all other purges 
by some practitioners, particularly if the liver is torpid. Jalap in 
large doses must be used with caution in persons who are feeble, 
and it is contraindicated in cases suffering from gastric or intestinal 
irritation. 

Administration. — Jalap may be given in the form of a compound 
powder (Pulvis Jalapa? Compositus, U. S. and B. P.), dose 15 to 40 
grains (1.0-2.6), which is composed of 35 parts of Jalap and 65 parts 
of bitartrate of potassium; and the resin (Resina Jalapa?, U. S. and 
B. P.), dose for an adult 2 to 4 grains (0.12-0.25). Owing to the 
small size of the dose of the resin and its lack of taste, this prepara- 
tion is to be preferred for children in the dose of \ to J grain (0.015- 
0.O3). The tincture (Tinctura Jalapa?, B. P.) is given in the dose of 
J to 1 fluidrachm (2.0-4.0) ; the extract (Extractum Jalapa, B. P.) is 
used in the dose of 5 to 15 grains (0.30-1.0). 



JUNIPER. 301 



JEQUIRITY. 



This is a plant known as Abrus precatorius, the seeds of which are 
poisonous when applied to a wound. An active principle, abrin, is com- 
posed of paraglobulin and a-phytalbumose, which closely resemble 
snake-venom in their action. Jequirity is never used internally in 
medicine in the United States. An infusion of the powdered seeds, made 
by adding \ a drachm to an ounce (2.0-32.0) of water at 140° F., may 
be painted with a brush on the inside of the eyelids in cases of chronic 
granular conjunctivitis, in order to produce an acute diphtheritic 
inflammation that will so change the chronic process present as to per- 
mit of cure. If an excessive action is developed, it may be controlled 
by hot compresses made of very dilute solutions of corrosive sublimate. 
The solution of the drug undergoes decomposition with great rapidity, 
and should be freshly prepared each time it is used, or 4 to 8 grains 
(0.25-0.5) of boric acid should be added to preserve it. The drug is a 
powerful cardiac depressant poison when injected into the circulation. 
Whether the seeds produce poisoning when swallowed is doubtful, 
some asserting that they cause gastro-enteritis, others that they are 
harmless. Probably much depends on the activity of digestion and 
absorption at the time of ingestion. 



JUNIPER. 

Juniperus is the fruit or berry of Juniperus communis, an evergreen 
of Northern Europe and America. It contains a volatile oil and an 
amorphous principle, juniperin. 

Physiological Action. — Juniper acts as a gastric stimulant and tonic, 
as a mild diaphoretic if combined with alcohol, and as a marked stim- 
ulating, exciting diuretic. It escapes from the body by the kidneys. 

Therapeutics. — Juniper is valuable as a stimulant to the genito- 
urinary tract whenever it is depressed or chronically diseased, as in 
chronic pyelitis, nephritis, and chronic catarrh of the bladder. In con- 
gestion of the kidneys, particularly that due to feeble circulation, if not 
accompanied by active renal changes, it relieves these organs and does 
away with albuminuria. Used after an attack of acute Bright's disease 
when reaction has set in and the secreting epithelium of the kidney is 
atonic, it is of value; but care should be taken that all inflammation 
has passed by or it will make the patient worse. In the later stages of 
scarlet fever, in which the renal condition corresponds to that just 
described, juniper is also useful. In old persons a sensation of weight 
across the lumbar region is often quickly removed by the use of juniper 
if the kidneys are inactive. 

Administration. — Juniper is used in the form of the compound 
spirit (Spiritus Juniperi Compositus, U. S.), composed of the oils of 
juniper, caraway, and fennel, combined with alcohol and water, in the 



302 DRUGS. 

dose of 1 to 4 drachms (4.0-16.0). Gin is virtually identical with the 
compound spirit. The infusion of juniper is made by adding an ounce 
(30.0) of the berries to a pint (480 c.c.) of boiling water and allowing it 
to stand in a warm place for an hour. The entire quantity is to be 
taken in twenty-four hours. This infusion is often combined with an 
ounce (30.0) of acetate of potassium or of the bitartrate of potassium 
in the treatment of dropsy. The spirit (Spiritus Juniperi, U. S. and 
B. P.) is given in the dose of 30 minims to 1 drachm (2.0-4.0). The oil 
(Oleum Juniperi, U. S. and B. P.) is used in the dose of 1 to 4 minims 
(0.05-0.25). 

KAMALA. 

Kamala, or Rottlera, as it is sometimes called, is the glands 
and hairs from the capsules of Mallotus philippinensis, a plant of 
Abyssinia, India, China, and Australia. It contains an active principle, 
rottlerin, which is not official. Given in the dose of 1 to 2 drachms 
(4.0-8.0), kamala acts as a drastic purge and as a remedy for tape- 
worm, and is sometimes used for the removal of ascaris lumbri- 
coides. It should be administered in a syrup in which is placed some 
hyoscyamus to prevent griping, and the dose is to be repeated in eight 
hours if no effect is produced. (See Worms.) 



KAOLIN. 

Kaolin (Kaolinum, U. S. and B. P.) is a soft white powder, a 
decomposition-product containing feldspar. It is used externally as 
a dusting-powder in eczema. Cataplasma Kaolini, U. S.) is used as a 
poultice. 

KINO. 

Kino (B. P.) is the insipissated juice of Pterocarpus marsupium, 
a tall tree of India. It contains kinotannic acid, and is used as an 
astringent in the treatment of serous diarrhoea. It is official in the form 
of the tincture (Tinctura Kino, U. S. and B. P.), and is given in the 
dose of 2 fluidrachms (8.0). Kino may be used as a gargle in sore throat 
and for relaxation of the uvula. Under the name of Compound Powder 
of Kino (Pulvis Kino Compositus, B. P.) an efficient and pleasant 
antidiarrhcea powder is used. This powder is not official in the U. S. P. 
The formula for each powder is 15 grains (1.0) of powdered kino, 4 
(0.2) of powdered cinnamon, and 1 (0.06) of powdered opium. 



KOLA. 

This drug is the nut of Kola acuminata, a tree growing in certain 
parts of Africa. The nut depends for its chief medicinal activity upon the 



LEAD. 303 

caffeine which it contains. In addition to this alkaloid it contains some 
theobromine and kolatannic acid,which latter ingredient may explain the 
good results which have followed the use of kola in cases of diarrhoea. 

Physiological Action. — The physiological action of kola is, as far as 
we know, nearly identical with that of its near relatives coffee and coca, 

Therapeutics. — In cases of feeble heart associated with general debil- 
ity kola often proves a valuable stimulant to the heart and general sys- 
tem, as well as to the kidneys. It has also been used with asserted 
success in sea-sickness and to sober drunken individuals, although the 
latter power is to be doubted. Its use will sometimes relieve sick and 
neuralgic headache. Recently a large number of semi-proprietary 
articles have been introduced to the laity with the statement that they 
increase muscular strength. Except for their temporary stimulating 
power they are useless for this purpose. The drug is, however, of 
value in cases of uterine inertia during labor in the dose of 30 minims 
to 2 drachms (2.0-8.0) of the fluid extract. 

Administration. — Kola is not official. It may be given in the form 
of the fluid extract (Extr actum Kolw Fluidum), dose 10 to 30 minims 
(0.60-2.0), or in an elixir. A very useful preparation, known as the 
Compound Elixir of Kola (Elixir Kolae Composita), contains kola, 
coca, and guarana, and may be given in the dose of 2 drachms (8.0). 
This forms a useful tonic in some cases of debility, particularly if 
arsenic is added to it. Thus : 

1$ — Liq. potassii arsenitis ttlxvj (1.0). 

Elix. kolse compositat. ..... f§iv (120.0). 

S. — Dessertspoonful (8.0) after meals. 

LANOLIN. 

Lanolin, which is practically Adeps Lana? Hydrosus of the U. S. 
and B. P., is a fat derived from the wool of the common sheep, and is a 
whitish substance of peculiar stability, very difficult of saponification, 
and incapable of becoming rancid. Unna states that ointments of 
acids, hydrogen peroxide, and other substances may be made by it. 
One great objection to lanolin is its stickiness, which is avoided by 
adding one-third of vaseline. Lanolin is supposed to possess very 
remarkable penetrating powers when applied to the skin in cases where 
much infiltration is present, particularly if it is combined with resorcin 
or some similar medicament. In itself it has little curative power, and 
is but little better than lard, suet, or any common fat as a basis for 
ointments. In some rare cases it causes irritation of the skin. 



LEAD. 

Plumbum, or Lead, is a metal possessing more or less influence over 
the organism according to the salts which are employed. It is not 
official as lead itself. 



304 DRUGS. 

Physiological Action. — Lead, in one of its soluble salts, if applied 
to a mucous membrane, by reason of its astringent effect produces a 
blanching which is particularly noticeable where the blush of inflam- 
mation has previously been present. It has little effect when given in 
a single dose, except by an indirect influence over the circulation, 
nervous system, or respiration. (For a description of the effects of 
lead in overdoses see " Poisoning," below.) 

The most irritant and poisonous of the soluble salts is the nitrate, 
the next the subacetate, and the least poisonous of the soluble salts is 
the acetate. 

The insoluble salts rarely cause acute poisoning, but frequently 
produce chronic plumbism. 

Acute Poisoning. — When the acetate of lead is taken in poisonous 
amounts, it produces a sweet metallic taste in the mouth, followed by 
pain in the epigastrium and the vomiting of white, milky-looking 
liquids or white curds mixed with food. The white color is due to the 
presence of chloride of lead formed by the acid of the gastric juice. 

The pain rapidly increases in severity, and diarrhoea due to gastro- 
enteritis may be set up, or, in other cases, obstinate constipation is 
present. The passages are generally black, this color being due to the 
presence of the sulphide of lead. At the same time the pulse becomes 
rapid, tense, and cord-like, but after a time weak and compressible. 
The face is anxious and pale or livid. The thirst is excessive and 
cramps in the calves of the legs or muscular twitchings may ensue. It 
is said that the characteristic blue line on the gums may occur in acute 
poisoning, but this is rarely if ever seen. If coma comes on in the 
course of acute lead poisoning, death is almost certain. 

The treatment consists in the use of the chemical antidote, a soluble 
sulphate, in large quantity, in the administration of emetics, and the 
use of the stomach-pump if the vomiting produced by the drug is not 
sufficient to rid the stomach of all the poison. The best soluble sul- 
phates to employ are Epsom and Glauber salts, because they are always 
at hand, are readily soluble, and, in excess, act as purges which will 
wash out the intestinal canal. Hot applications should be applied to 
the belly and feet, and the pain and irritation which are present should 
be relieved by opium. 

Chronic Poisoning. — Chronic lead poisoning is rarely produced by 
the soluble salts of lead, nearly always being due to the insoluble salts. 
The symptoms of chronic lead poisoning, or plumbism, are as various 
as it is possible to find variety in the signs of disease of every kind. 
There is no train of symptoms which may not occur, and the occurrence 
of rare, anomalous symptoms in a given case should at once bring to 
the mind of the physician the thought of lead poisoning or syphilis. 
Chronic poisoning occurs in painters, manufacturers of lead salts, and 
every one who is largely brought in contact with the metal in the arts. 
It occurs from the use of hair-dyes containing the acetate of lead, from 
drinking water which has passed through new lead pipe, and even 



LEAD. 305 

from the biting of silk threads weighted with salts of lead. Chroruate 
of lead has been used to color sponge-cake when eggs were thought too 
expensive for the purpose, and has killed many persons. Millers who 
have filled the holes in grindstones with lead have caused widespread 
epidemics of what has been called "dry cholera," and many persons 
have suffered from lead poisoning from eating apple-butter kept in 
jars glazed with lead. 

One of the most prominent, but by no means the most constant, 
symptoms of chronic plumbism is bilateral wrist-drop, due to palsy of 
the extensor muscles of the forearm. The short extensor of the thumb 
generally escapes the drug's influence, as does also the supinator longus. 
Sometimes internal squint arises from paralysis of the external rectus 
muscles by the lead. Another very common symptom is severe colic 
centering around the umbilicus and radiating through the belly and 
loins. Obstinate constipation often accompanies these symptoms, and 
the feces, when passed, are white and clay-colored, owing to a deficient 
secretion of bile. During an attack of lead colic the arterial tension is 
increased very markedly, the tongue is coated and whitish, and the 
bowels are obstinately confined. 

If these early warnings are disregarded and the exposure to the lead 
is continued, cerebral symptoms may come on, the result of encephalo- 
pathia saturnina, or saturnine cerebritis. Saturnine epilepsy is not 
very rare. If convulsions come on, death generally ensues. The con- 
vulsions in some cases are not due to a cerebral effect of the lead, but to 
ursemia due to the renal changes which it has caused. 

Renal disease is very commonly produced by lead, and it is not 
uncommon for chronic contracted kidney to be found at the autopsy of 
a sufferer from chronic lead poisoning. If a patient with chronic lead 
poisoning have a urine with a persistent low specific gravity, the prog- 
nosis is grave, as evidencing advanced kidney involvement. 

Asthma due to the inhalation of lead-dust is sometimes met with. 

The most important confirmatory evidence of chronic lead poisoning is 
a blue line on the gums just where they join the teeth. Its absence is not 
a negative sign, however, as poisoned persons cleanly in respect to 
their mouths often do not have it. Marked cachexia or anaemia is 
commonly seen in chronic lead poisoning. 

After prolonged lead poisoning the nerve trunks are found atrophied, 
and finally changed into fibrous cords. Anterior poliomyelitis may be 
present, but true locomotor ataxia is rarely caused. If ataxic symp- 
toms exist, they are most probably dependent on pseudo-tabes pro- 
duced by a plumbic multiple neuritis, and can be separated from true 
tabes dorsalis by the absence of several of the important true tabetic 
symptoms — such as slow onset, the Argyll-Robertson pupil, etc. — 
while the presence of marked wasting and loss of power, and some- 
times tenderness over the nerve-trunks, points to neuritis. 

In some cases trophic changes in the joints ensue, and plumbic gout 
is not rarely seen, or even lead arthralgia, with deposits of urates in the 

20 



306 DRUGS. 

joints. This condition is due to the fact, pointed out by Garrod and 
Haig, that lead forms insoluble salts with uric acid. 

Lead escapes from the body in the urine, the feces, and all secre- 
tions. It is chiefly eliminated by the liver in the bile. 

Treatment of Chronic Poisoning. — The treatment consists in 
three classes of remedial measures: 1st, the removal of the cause; 
2d, the removal of the poison in the body; and, 3d, the treatment of 
the lesions produced by the poison. 

In lead colic hepatic purges, such a; jalap and calomel, combined 
with opium to prevent pain, are indicated, and alum and opium or 
morphine are said to be almost specifics, the alum in 2-grain doses, the 
others in full amounts. In many cases purges fail to move the bowels 
of a person suffering from chronic lead poisoning, and succeed only 
when morphine is given to overcome the intestinal inhibition produced 
by the irritation caused by the lead. 

In the cerebral inflammation of lead poisoning a blister to the back 
of the neck, revulsives, and a pilocarpine sweat may be resorted to. 

To aid in the elimination of the lead, iodide of potassium, which 
forms double soluble salts in the tissues w T ith the metal, is to be used, 
10 to 20 grains (0.60-1.3) three times a day. 

If progressive paralysis is present, Wood insists on the use of large 
doses of strychnine at the same time that the iodide is given, The 
strychnine should not, of course, be given in the same mixture as the 
iodide, as it is incompatible. 

Electricity should be used as a remedy to restore lost function. If 
the faradic current makes the muscles contract, it should be employed, 
and if not, the galvanic current should be used. Curiously enough, 
partial voluntary power sometimes returns before the muscles will 
react at all to electricity. 

It is said that baths of sulphuret of potassium do good in chronic 
plumbism, 5 or 6 ounces (180.0) of the salt to each bath, which is to be 
given in a wooden tub. The patient should afterward be well soaped, 
then thoroughly rinsed off, and rubbed down with a rough towel. 

As the salts of lead are used for different purposes, the therapeutics 
of each one will be taken up separately. 

Acetate of Lead. 

Acetate of Lead (Plwnbi Acetas, U. S. and B. P.), or Sugar of Lead, 
has a sweet, astringent taste, and is soluble in water, but the solution 
formed is slightly milky in appearance. 

Therapeutics. — Acetate of lead may be used, and is largely employed 
in the following pill in the treatment of serous diarrhoea: 

1^— Plumbi acetat. : - . . gr. xl (2.60). 

Pulv. opii x (0.60). 

Camphorse gr. xl (2.60).— M. 

Ft. in pil. No. xx. 

S. — One every four hours. 



LEAD. 307 

This pill may also be given in cases of dysentery. 

The acetate of lead in proportion of 1 to 8 grains (0.06-0.5) to the 
ounce of water may be used as an injection for gonorrhoea. 

Lead acetate is also a useful application for the dermatitis produced 
by poison ivy, as this drug precipitates the sticky, non-volatile oil 
of Rhus toxicodendron, recently studied by Pfaff. The acetate 
should be dissolved in alcohol in the proportion of \ grain to the 
ounce (0.03-30.0) and used as a wash. After this the inflamed parts 
should be treated by cooling applications, but ointments are not to be 
used, as they dissolve the poisonous oil and spread the irritation. 

Administration. — The B. P. recognizes the following preparations 
of lead acetate : Piluloz Plumbi cum Opio, dose 3 to 5 grains (0.12-0.3) ; 
Suppositoria Plumbi Composita, each suppository containing 1 grain 
(0.06) of opium to 3 grains (0.20) of lead acetate; and an ointment 
{Unguentum Plumbi Acetatis), 

Carbonate of Lead. 

Carbonate of Lead {Plumbi Carbonas, B. P.), or White Lead, is 
insoluble, and is used as a coating or dressing for burns, scalds, or 
ulcers when rubbed up with linseed or other oil, or in the form of the 
ointment {Unguentum Plumbi Carbonatis, B. P.). If an extensive 
surface is covered with this ointment, it may cause subacute lead 
poisoning by absorption. 

Carbonate of lead may be used in the treatment of sunburn in the 
following prescription : 

1^ — Plumbi carbonat 5j (4.0). 

Pulv. amyli 5j (4.0). 

Unguent, aquae rosse Sj (30.0). 

Olei olivse . . . f 5ij (8.0).— M. 

S. — Apply to the inflamed skin. 

Iodide of Lead. 

Iodide of Lead {Plumbi Iodidium, U. S. and B. P.) is occasionally 
employed in medicine; the dose is \ to 2 grains (0.03-0.12). Emplas- 
trum Plumbi Iodidi, B. P., and Unguentum Plumbi Iodidi, B. P., are 
used as external astringent and alterative applications, but are rarely 
useful. 

Liquor Plumbi Subacetatis. 

Liquor Plumbi Subacetatis, U. S., and Liquor Plumbi Subacetatis 
Fortis, B. P., or Goulard's Extract, is a colorless liquid, much used 
externally, when diluted with laudanum, for sprains, bruises, and local 
inflammations, under the name of " lead-water and laudanum." 
"L» and L.," as it is often called in the hospitals, is a useful applica- 
tion in the dermatitis produced by poison ivy. The proportion should 
be 4 parts of the undiluted lead-water, diluted with 16 parts of water 



308 DRUGS. 

to 1 of laudanum, but this is varied as the inflammation or pain is the 
more severe. The official liquor is also official in a dilute solution 
(Liquor Plwnbi Subacetatis Dilutus, U. S. and B. P.), and as such is too 
weak for ordinary use, although it is commonly employed. The strong 
solution should be used in the strength of from 1 to 4 ounces (30.0- 
120.0) to the pint (480 c.c.) of water. This solution should never be 
employed if the skin is broken, as absorption may occur, and, what is 
more important still, the drug prevents healing by constringing the 
edges of the wound. 

If some bread-crumbs be saturated with the solution just named and 
applied to an inflamed finger, a felon can often be aborted in the early 
stages. The official dilute solution is useful as a lotion in eczema which 
itches and tingles and is not dry in character. It should be applied 
once or twice a day, and it is well to follow the application of lead with a 
weak sulphur bath or alkaline wash. (See Eczema.) 

Lead-water is also useful in pruritus pudendi. The cerate (Ceratum 
Plumbi Subacetatis, U. S.), the liniment (Linimentum Plumbi Subace- 
tatis), and the glycerin (Glycerinum Plumbi Subacetatis, B. P.) may 
be used for the same purposes as Goulard's extract. 

Lead acetate is used for the preparation of lead plaster (Emplas- 
trum Plumbi, U. S. and B. P.), sometimes called " Diachylon plaster." 

Hebra recommended for sweating of the feet an application of equal 
parts of lead plaster and linseed oil, applied on linen and wrapped 
around the feet every third day. 

Litharge. 

Litharge (Plumbi Oxidum, U. S. and B. P.) is used in the prep- 
aration of the solution of subacetate of lead. 



Nitrate of Lead. 

Nitrate of Lead (Plumbi Nitras, U. S.) is never used internally, 
but as a powder, in the treatment of cases of onychia maligna and in 
the formation of Ledoyen's disinfecting solution. The latter dis- 
colors the paint in water-closets, dissolves the solder in drain-pipes, 
and is not a good preparation for general use. 



LEPTANDRA. 

The medicinal portion of Veronica virginica is the rhizome and 
rootlet, from which are made the official extract of leptandra (Extrac- 
tum Leptandrce, U. S.) and the fluid extract (Fluidextractum Lep- 
tandrw, U. S.). The dose of the former is from 1 to 8 grains 
(0.06-0.5) and of the fluid extract 5 to 40 minims (0.3-2.6). 



LIPANIN. 309 

Physiological Action. — Very few experiments have been made as 
to the action of this remedy, and the only ones of importance are 
those of Rutherford and Vignal, who found that it possesses a moderate 
influence in increasing the flow of bile. In overdose it causes violent 
purging. 

Therapeutics. — In the official preparations of leptandra, which are 
not so active as is the fresh drug, are excellent substitutes for calomel, 
according to many clinicians. Those who have used leptandra 
also believe it to be of the greatest value in the indigestion of the 
intestinal type sometimes called "duodenal atony." (See also Podo- 
phyllin.) The following pill is a good method of using the drug in 
these cases: 

1^ — Ext. chiratse gr. xx (1.3). 

Ext. leptandrse gr. xx (1.3). — M. 

Ft. in pil. No. x. 

S. — One pill after each meal. 

Under the name of leptandrin we have an impure resin which is 
given in the dose of 2 to 5 grains (0.12-0.3). An alkaloid of doubtful 
existence is called leptandrine. 

LEVULOSE. 

Levulose is a monosaccharide sweeter than cane-sugar, and if pure 
free from glucose. It is used in medicine as a substitute for sugar in 
the dietetic treatment of diabetes, and is absorbed as levulose and 
is readily oxidized in the body. Levulose may be taken by diabetic 
patients in the dose of 1 to 2 ounces a day without injury in many 
instances, and tends to promote nutrition. It has also been used with 
advantage in poorly nourished children and by tuberculous persons 
whose digestion cannot cope with cane-sugar. One firm places it on 
the market under the name of "Diabetin." 



LIPANIN. 

Lipanin is an artificially prepared mixture devised by von Mering 
as a substitute for cod-liver oil, and consists in 6 parts of oleic acid 
added to 100 parts of olive oil.- The advantages possessed by it are 
its lack of disagreeable odor and taste and its ready emulsification 
and digestibility. The commencing dose is 1 drachm (4.0), which 
may be increased to 4 drachms (16.0). This mixture has been found 
of value in most of the wasting diseases in which cod-liver oil is em- 
ployed, and in the opinion of von Mering its efficacy is greatly increased 
if the hypophosphites of lime and sodium are used at the same time in 
the dose of 10 grains (0.60) three times a day. Iodine or one of its 
compounds may also be given if it is desired to exert an alterative 
influence. 



310 DBUG& 



LIQUORICE. 



Liquorice (Glycyrrhiza, U. S., and Glycyrrhiza? Radix, B, P.) is 
the root of Glycyrrhiza glabra, a plant of Southern Europe and Asia. 
In the form of a solid extract it is used to increase secretion in the 
mouth, and when dissolved in water to form a vehicle for other drugs, 
particularly if they have a disagreeable taste. The powdered solid 
extract is a very mild and useful laxative. 

Administration. — The solid extract (Extractum Glycyrrhiza?, U. S. 
and B. P. is used in a dose varying from 5 to 120 grains (0.30- 
8.0). The pure extract (Extractum Glycyrrhiza? Purum, U. S.) is 
used in the same quantities as the ordinary extract. The fluid extract 
(Eluidextr actum Glycyrrhiza?, U. S.) or the liquid extract (Extractum 
Glycyrrhiza? Liquidum, B. P.) is used in 1- to 2-drachm (4.0-8.0) doses, 
and enters into the preparation of adjuvant elixir (Elixir Adjuvans, 
U. S.). Under the name of Brown Mixture or " Compound Liquorice 
Mixture" a very efficient expectorant solution is official (Mistura 
Glycyrrhiza? Composita, U. S.), which contains as its most important 
ingredients 12 parts of paregoric, 6 parts of wine of antimony, and 
3 parts of sweet spirit of nitre. The dose of Brown Mixture is 1 to 4 
drachms (4.0-16.0). Pulvis Glycyrrhiza? Compositus, U. S. and B. P., 
or compound liquorice powder, contains, according to the U. S. P., 
18 per cent, of senna, 23.6 per cent, of liquorice, 4 per cent, of oil of 
fennel, 8 per cent, of washed sulphur, and 50 per cent, of sugar. 
According to the B. P., it should contain 2 parts of senna, 2 of 
liquorice-root, 1 of fennel-fruit, 1 of sublimed sulphur, and of sugar 
6 parts. The dose is 1 to 4 drachms (4.0-16.0). It is largely used as 
an efficient laxative after childbirth and in cases which suffer from 
constipation chiefly due to the inactivity consequent upon being in 
bed. The troches (Trochisci Glycyrrhiza? et Opii, U. S.) contain -^ 
grain (0.003) of opium and 2 grains (0.12) of extract of liquorice. 
Finally we have Glycyrrhizinum Ammoniatum, U. S., which is the 
sweet principle of liquorice rendered soluble and easily tasted by the 
addition of ammonia. The dose of this preparation is 5 to 15 grains 
(0.3-1.0). 

LIQUOR POTASSII HYDROXIDI. 

Liquor Potassii Hydroxidi, U. S. ; Liquor Potassa?, B. P., is a solu- 
tion of potassa containing about 5 per cent, of potassium hydroxide 
and is a clear, odorless liquid of caustic taste and strongly alkaline 
reaction. It is used in medicine as an antacid and for the purpose 
of decreasing the acidity of the urine. Its dose is 5 to 30 minims 
(0.30-2.0) well diluted with water. 

In cases of ingrowing toe-nail it is often used to soften the nail prior 
to packing with cotton or partial evulsion. 



LOBELIA. 311 



LITHIUM. 



Lithium is used in several forms, but its salts may be divided into 
two classes — those which act as lithium and those which act as the 
acids forming them. In the first class are the carbonate (Lithii 
Carbonas, U. S. and B. P.), dose 2 to 10 grains (0.12-0.60), the citrate 
(Lithii Citras, U. S. and B. P.), dose 5 to 20 grains (0.3-1.3), and 
the effervescent citrate (Lithii Citras Effervescens, U. S. and B. P.), 
dose 1 to 4 drachms (4.0-16.0). In the second class are the ben- 
zoate (Lithii Benzoas, U. S.), dose 5 to 30 grains (0.3-2.0); Lithii 
Bromidum, U. S., dose 10 to 40 grains (0.60-2.60), and Lithii Salicylas, 
U. S., dose 10 to 30 grains (0.60-2.0). 

The carbonate and citrate are used in gout and rheumatoid arthritis 
for the purpose of entering into combination with the uric acid in the 
body to form soluble urates and prevent deposits in the joints. They 
have been said to dissolve calculi, but this is untrue, though they 
are used when it is desired to render the urine alkaline. Haig has 
pointed out that although lithium forms salts with uric acid in the test- 
tube, in the body it has a greater affinity for the acid sodium phos- 
phate in the blood, and practically leaves the uric acid to itself. This 
is an important point, since it proves that the large amount of water 
generally taken with lithium salts has more to do with relieving gout 
than has the lithia. The carbonate is not soluble in water, and should 
be given in capsule or freshly-made pill, but the citrate is soluble. The 
latter may be made from the former by taking 50 grains (3.5) of the 
carbonate, 90 grains (6.0) of crystallized citric acid, and warm dis- 
tilled water 1 fluidounce (30.0). The acid should be dissolved first, 
and the carbonate added to the solution. The solution should then 
be kept hot until effervescence ceases. 

In cases of diabetes depending upon a gouty taint remarkable results 
are said to be obtained from the use of the citrate or carbonate of 
lithium and arsenic. The dose should be -^ grain (0.C02) of arsenite 
of sodium and 10 grains (0.60) of the lithium salt three times a day. 

It is worthy of note that in some cases citrate of lithium will dis- 
order the stomach and produce vomiting; and overdoses produce gen- 
eral relaxation of the system with a sense of feebleness. 

(For the use of other salts of lithium see the articles on the Bro- 
mides, Salicylic Acid, and Benzoic Acid.) 

(See also article on Mineral Springs.) 



LOBELIA. 

Lobelia, U. S. and B. P., is the leaves and tops of Lobelia infata, 
a common weed of the United States. It contains an alkaloid, lobe- 
line, and lobelic acid. 



312 DRUGS. 

Physiological Action. — When taken in overdose lobelia causes erne- 
sis, intense prostration, a feeble pulse, pale skin, livid face, muscular 
relaxation, and a cold sweat. Violent purging may be present. It 
is said to paralyze the motor nerve-trunks, and it causes a fall of arterial 
pressure, followed by a rise, the latter change being due to the asphyxia 
which it finally produces. Ultimately it paralyzes the respiratory 
centre and the peripheral vagi. The treatment of the poisoning is 
to administer opium to allay irritation and check vomiting, to give 
alcohol and ammonia to support the heart, and the use of external heat. 

Therapeutics. — Lobelia is used chiefly as an antiasthmatic, and has 
been equally praised and condemned by eminent authorities. The 
reason for this lies in the fact that it is generally useless in asthma 
unless given in almost poisonous dose. Wood teaches that it should 
rarely if ever be used, because of its poisonous effects even in doses 
medicinally active, while Sydney Ringer says that the drug is erro- 
neously thought to be dangerous. In asthma both of the gastric and 
bronchial form lobelia is undoubtedly of service. In some cases it 
fails as signally as it succeeds in others. If the asthma is due to or 
associated with cardiac disease, lobelia should never be employed. 
The drug should be taken in the dose of \ drachm (2.0) to 1 drachm 
(4.0) of the tincture at the first sign of an attack, or in 10-minim (0.60) 
doses every fifteen minutes until distinct nausea occurs or relief is 
obtained. If the heart is feeble, its use is contraindicated. 

In atonic constipation with great dryness of the feces 10 minims (0.60) 
of the tincture of lobelia at bedtime are often of service, particularly 
if it is combined with cascara sagrada. (See Cascara Sagrada.) 

Administration. — Lobelia is given in the form of the tincture (Tine- 
tura Lobelia?, U. S.), in the dose of 10 to 60 minims (0.60-4.0), as a 
sedative, or 2 to 4 drachms (8.0-16.0), as an emetic. The vinegar 
(Acetum Lobelia:) is no longer official, but is given in the dose of 
20 to 30 minims (1.3-2.0), and the fluid extract (Fluidextr actum 
Lobelia?, U. S.) in the dose of 1 to 5 minims (0.05-0.30), or as an 
emetic in the dose of 15 minims (1.0). 

In the form of the infusion lobelia is useful as a lotion in the treat- 
ment of the dermatitis produced by poison ivy. The proportion used 
should be an ounce (30.0) to the pint (480 c.c.) of water. 

The preparation of the B. P. is Tinctura Lobelia? Miherea, dose 
10 to 30 minims (0.60-2.0). 

LYCETOL. 

(See PlPEKAZINE.) 

LYCOPODIUM. 

Lycopodium is a pale-yellow powder derived from Lycopodium 
clavalum, a species of moss. It is used by pharmacists as a 



MAGNESIUM. 313 

powder in which to roll pills, and by physicians and nurses to prevent 
the intertrigo or chapping of the skin of infants and adults. 

LYSOL. 

Lysol is a preparation made by dissolving in fat and saponifying 
with alcohol that part of tar oil which boils between 190° and 200° 
C, and is a brownish, clear, oily fluid, smelling somewhat like creo- 
sote. It is used for the same antiseptic purposes as creolin (see Creo- 
lin) , but possesses the advantage of forming a clear, soapy fluid when 
mixed with water, in which instruments can be seen. If small instru- 
ments are used, the solution is so soapy that it renders them too slippery 
for ready use. Those who have used lysol claim that it does not affect 
the skin of the operator's hand except to render it soft and flexible. 
Used upon mucous mem6ranes, a solution of lysol should not be 
stronger than 2 per cent. Liquor Cresolis Compositus, U. S., is 
similar to Lysol. 

MAGNESIA. 

Magnesia is the oxide of magnesium (Magnesii Oxidum, U. S.), 
made by exposing the carbonate of magnesium to a red heat. It is 
used in the form of the light magnesia (Magnesia Levis, B. P.) as a 
dusting-powder. The troches (Trochisci Magnesia?) each contain 3 
grains (0.20). Magnesii Oxidum Ponderosum, U. S., is official in the 
B. P. as Magnesia Ponder osa. 

Magnesia is an antidote to arsenic, and when employed to precipi- 
tate a soluble preparation of iron it forms the Antidotum Arsenici 
(Ferri Hydroxidum cum Magnesia, U. S.). 

It is important that the student should not confuse magnesia and 
magnesium. The first is the oxide of the second, and is sometimes 
called calcined magnesia or "Husband's Magnesia." Magnesia is of 
little value in internal medicine except as a feeble antacid. Magnesia 
and the carbonate of magnesium may be used interchangeably. 

MAGNESIUM. 

Magnesium is a metal never used as such, but always in the form 
of one of its salts, which are the sulphate, citrate, carbonate, and sul- 
phite. The sulphite is a natural salt found in sea-water and in caves 
or in the water coming from the latter. The citrate and carbonate 
are derived from the sulphate. The carbonate is insoluble in water 
and alcohol. The others are soluble. 

Magnesium Carbonate. 

The Carbonate of Magnesium (Magnesii Carbonas, U. S.) is official 
in the form of the heavy and light powder (Magnesii Carbonas Pon- 



314 DRUGS. 

derosus and Levis, B. P.), and these two substances do not differ in 
respect to their effects. The light magnesium is never given internally, 
because of its bulk, but it is used as a dusting-powder in intertrigo, 
and in the form of white cubes rubbed on the skin to prevent exces- 
sive perspiration and as a cosmetic. The heavy magnesium is used 
as an antacid, and is not, as has been thought by some, in any sense 
a laxative, as it possesses no such power. When the stomach or intes- 
tines contain much acid from fermentative changes, these acids may, 
however, unite with the magnesium and form a slightly laxative salt. 

In sick headaches due to excessive gastric acidity carbonate of magne- 
sium is often of service. The dose of the carbonate is from 5 to 60 
grains (0.3-4.0). It should not be used constantly, as there is danger 
that it will accumulate in the intestines. 

Liquor Magnesii Carbonatis, B. P., is given in the dose of 1 to 2 
ounces (30.0-60.0) as a laxative. 

Magnesium Citrate. 

The Citrate of Magnesium (Magnesii Citras) is a more irritating 
purge than the sulphate, but it is more agreeable to the taste. It is 
official as Liquor Magnesii Citratus, U. S., which is effervescent and 
should never be us 3d unless freshly prepared. It is made by add- 
ing bicarbonate of potassium to a syrupy solution of the citrate 
of magnesium containing an excess of acid, and corking the bottle 
tightly, the cork being tied down with a strong cord. Care should 
be taken that the bottle is a strong one, as the development of 
large amounts of carbonic acid gas may burst it if it be weak. The 
dose is half to one bottle, which contains about 12 ounces (360 c.c). 
It is too irritating to be used where inflammation of the alimen- 
tary canal exists, but is useful in the treatment of sick and bilious 
headache. 

The Granulated Citrate (Magnesii Citras Effervescens) is less 
agreeable to take than the solution just named. It should be dis- 
solved in water, about 1 to 3 drachms (4.0-12.0) of the salt being 
used in each dose, and swallowed while the solution is effervescing. 
It must be kept in bottles tightly corked. 

Magnesium Sulphate. 

Sulphate of Magnesium (Magnesii Sulphas, U. S. and B. P.) is a 
white granular powder of neutral reaction and salty taste, and is sol- 
uble in water. It is generally known as "salts," although in some 
parts of the United States this term also includes the sulphate of sodium 
and "Rochelle salt," or the tartrate of sodium and potassium. 

Sulphate of magnesium is a purge by reason of its abstraction of 
water from the intestinal bloodvessels, because it stimulates peri- 
stalsis directly and by reason of the fact that solutions of it are 
not readily absorbed. As a result of these three factors free passages 



MAMMAE Y GLAND. 31 5 

are produced, the bowel being filled by the water of the original solu- 
tion and the liquid poured out by the bowel wall. x*Ul strong saline 
solutions above the strength of 7 per 1000 abstract liquids from the 
tissues when brought in contact with them, and therefore whenever 
a thorough purgative action is required — that is, where depletion of 
the intestine or absorption of exudations is to be attained — the magne- 
sium should be given in concentrated form, so as to make its solution 
as of high a percentage as possible. 

In cases of dropsy the use of concentrated solutions is particularly 
necessary if free watery evacuations are desired, and from 1 to 2 ounces 
should be given before breakfast or on an empty stomach in as little 
water as will dissolve the salt. (See Dropsy.) Generally it is better 
to give this quantity divided into small doses every fifteen minutes 
till it is all taken. 

In enteritis and peritonitis the use of magnesium is widely recog- 
nized as a proper measure for its depletant effects, and it is claimed 
to be better than ipecac in the treatment of tropical dysentery. When 
used for the latter purpose it should be given in drachm (4.0) doses 
of a saturated solution with 10 to 15 drops (0.60-1.0) of aromatic 
sulphuric acid every two hours. The sulphate is not irritating, and 
may be given freely when inflammation exists. (See Peritonitis.) 

Magnesium sulphate forms a large part of most of the natural 
purgative waters, but in them is present in very dilute form. These 
waters act partly by supplying the contents of the bowel with fluid 
and thereby softening the feces, the solution not being absorbed 
because of the salt contained in it. 

Sometimes severe attacks of renal pain occur in middle-aged 
persons who have frequent attacks of gravel, and the urine will be 
found to contain octahedral crystals of calcium oxalate. A useful 
treatment is to give h to 1 drachm (2.0-4.0) of magnesium sulphate 
with equal parts of citrate of potassium twice or thrice a day, in water, 
for a considerable period of time. 

Magnesium sulphate may be given by enema with the double pur- 
pose of unloading the bowels and acting as a depletant. The best 
mixture for this purpose seems to be that of Watkins — namely, 2 
ounces (60.0) of magnesium, 1 ounce (30.0) of glycerin, and 4 ounces 
(120.0) of water. 

The U. S. P. and B. P. contain an official preparation called Mag- 
nesii Sulphas Effervescens, which is granulated, and is given in the 
dose of 4 to 8 drachms (16.0-30.0). 

MAMMARY GLAND. 

The extract of mammary gland of the common sheep has recently 
come into general use in the treatment of cases of subinvolution of the 
uterus and for the purpose of arresting metrorrhagia or other forms 
of loss of blood from the uterus. It is said by some physicians to 



316 DRUGS. 

exercise a good effect upon the bleeding and growth of many uterine 
fibroids, but cannot, of course, cure the condition. The dose of extract 
of mammary gland is 5 (0.3) grains three times a day, or, if hemor- 
rhage is free, as much as 6 doses a day may be used. Overdoses 
cause cardiac palpitation, but moderate doses seem to affect general 
nutrition favorably. Bleeding from soft fibroids is not so favorably 
affected by its use as that from hard fibroids. 

MANGANESE. 

MaDganum, or Manganese, is official in the U. S. P. in the form of 
the black oxide (Mangani Dioxidum Pracipitatum) , the sulphate 
(Mangani Sulphas), and the hypophosphite (Mangani Hypophosphis) . 
The first of these, under the name binoxide of manganese, has been 
highly praised in amenorrhea dependent upon functional distuibance 
and anaemia. The dose is 3 to 5 grains (0.20-0.3) three times a day, 
in pill form, and the drug should be taken for a few days before the 
expected or proper date for menstruation. The sulphate is rarely 
if ever employed, but may be tried in malarial jaundice. The dose 
is 1 to 2 grains (0.06-0.12). The hypophosphite enters into the com- 
pound syrup of hypophosphites. 

MANNA. 

Manna , U. S., is the concrete saccharine exudation of Fraxinus 
ornus, a tree of Europe. It occurs in roundish masses of varying 
size, looking somewhat like a gray-colored gum arabic. It has a sweet 
taste and odor. Sometimes the taste is a little bitter. 

Therapeutics. — Manna is the most feeble of the laxatives, and 
causes slight flatulence in some persons. In children fed by the 
bottle one of the most frequent disorders is obstinate constipation, and 
for its relief 1 to 2 drachms (4.0-8.0) of the sweet variety of manna 
may be dissolved in the milk of each bottle. When given to older 
children or adults, manna is always combined with other more power- 
ful drugs, chiefly to disguise their taste. It may be combined with 
advantage with rhubarb and senna, and it enters into the official 
Infusum Sennw Compositum, U. S., the dose of which is from 1 to 4 
fluidounces (30.0-120.0). 

MATRICARIA. 

Matricaria, U. S., German Chamomile, consists in the flower-heads 
of Matricaria Chamomilla, a European plant, possessing mild bitter 
tonic properties when given in moderate dose. In larger amounts it 
acts as an emetic and anthelmintic. In the form of an infusion of the 
strength of 1 to 2 ounces to the pint (30.0-60.0 : 480 c.c.) it has been 
largely used as a diaphoretic, and, in small doses, to prevent colic in 
teething children. 



MERCURY. 317 

MENTHOL. 

(See Peppermint.) 

MERCUROL. 

Mercurol is a chemical compound of mercury and nuclein, and 
possesses active germicidal power over pyogenic organisms. It is 
said to be particularly destructive to the gonococcus and to be of value 
in both gonorrhoea and gonorrheal ophthalmia. It does not coagulate 
albumin nor act as an irritant, and is readily soluble in water. In 
making the solution it should be placed on the surface of the fluid, as it 
dissolves best in this way. The solution for gonorrhoea should be of 
the strength of J to 1 per cent. In very obstinate cases as strong a 
solution as 2 per cent, may be needed. It is best given by injection 
into the urethra in normal salt solution. 

MERCURY. 

Hydrargyrum, U. S. and B. P., Mercury or Quicksilver, is a heavy 
fluid metal of a peculiar color and appearance. As metallic mercury 
it is used in medicine in the form of the ointment, the plaster, gray 
powder, and blue mass and the unofficial gray oil. 

Physiological Action. — When mercury is taken into the body in one 
of its insoluble and mild preparations, it may cause no evidence of its 
presence until by frequent and excessive dosage the system in general 
begins to feel its influence. The first evidences of this are to be found 
in the mouth, and consist in tenderness of the teeth when the jaws are 
firmly and quickly closed, fetid breath, sponginess of the gums, which 
finally may bleed at the slightest touch, swelling of the tongue, and, 
most prominent of all, excessive salivation, a condition sometimes 
called ptyalism. If the use of the drug is persisted in, all these symp- 
toms grow worse. Eczema, and finally sloughs of the chin and chest 
develop as the result of the constant dribbling of saliva and the direct 
depressing effect of the drug on the tissues. The teeth drop out, the 
maxillary bones undergo necrosis, and amid a general melting down 
and decomposition of the tissues the patient dies. The blood is affected 
and becomes very thin, fluid, and poor in its corpuscular elements. 
These symptoms ensue on the use of mercury in continued overdoses, 
and rarely follow exposure to the drug in the processes of the arts. 
In the arts — as, for instance, in the making of looking-glasses — work- 
men are often affected by various trains of symptoms varying very 
widely in their course. In some cases the nervous system becomes 
chiefly affected. Tremors of all sorts arise, paralysis agitans is devel- 
oped, and the results of peripheral neuritis ensue; but it is worthy of 
note that the ocular muscles are rarely involved in mercurial tremor, 



318 DRUGS. . 

while in disseminated sclerosis nystagmus is not rare. Similarly the 
tremors of mercurial poisoning often affect the head and neck alone, 
while in pa alysis agitans this is rarely the case. Chorea often comes 
on in chronic mercurial poisoning, and the occurrence of choreic 
movements in an adult should cause inquiry as to any possible exposure 
to mercury. In other cases brownish discoloration of the skin, resem- 
bling Addison's disease, appears. Blindness, deafness, sensory 
disturbances, such as hyperesthesia and anaesthesia, may be devel- 
oped, and localized wasting of muscles or groups of muscles may 
assert itself. In still other cases the blood becomes impoverished and 
mercurial cachexia is developed. 

It is worthy of note that children under three years are rarely sali- 
vated by the use of mercury, but this is no reason for using this drug 
carelessly in this class of cases, since the other changes in the organism 
nevertheless occur. 

Absorption and Elimination. — The rapidity of absorption and 
elimination of mercury depends to a great extent on the variety 
of it which is given. The drug in some forms is so insoluble that 
great delay in its elimination must often ensue because it is slowly 
absorbed. Several opinions are held as to the form in which mercury 
is absorbed. It is usually taught in France that the theory of Miahl 
is correct; this is, that the mercurial preparations are transformed 
in the stomach and intestine into the bichloride, which in turn unites 
with the sodium chloride in the blood and circulates as a double chloride 
of mercury and sodium. In Germany it is taught that it forms an 
albuminate of mercury and so circulates (Henoch's theory), or that 
it forms a chloro-albuminate (Voit's theory). All these theories as 
to its absorption are open to grave criticism.. As to the elimination 
of mercury, it is known to escape as an albuminate by every excretion 
of the body — the urine, feces, sweat, tears, milk, and saliva. After 
a single dose the drug begins to be eliminated in about two hours 
according to Byasson, and it is entirely gotten rid of in twenty-four 
hours. If, however, the doses are repeated, it gradually accumulates 
in the body, and is so slowly eliminated as to remain for almost in- 
definite periods of time, and is found deposited in all the organs. In 
other words, the doses of mercury ordinarily given are always large 
enough to produce cumulative effects. Thus while Balzer and 
Klumpke agree with Byasson as to the rapidity of elimination of a 
single dose, they find from an experimental study that the amount of 
mercury which can be eliminated by the kidneys for many weeks 
when the body is saturated with the drug is only one-sixteenth of a 
grain a day. It is evident, therefore, that after a full mercurial effect 
is produced it is well to decrease, as do most syphilographers, the 
dose of mercury and give only sufficient to maintain the effect. It 
is also evident that the plan of using iodide of potassium every 
now and again to aid in the elimination of the residual mercury is 
advisable. 



MERCURY. 



319 



Therapeutics. — The employment of mercury in medicine centres 
around four great points — viz.: 1st, its value in syphilis and kindred 
states; 2d, its use as a purge; 3d, its power as an antiseptic and germ- 
icide; and 4th, its action as an antiphlogistic; the first and fourth 
points are fulfilled by all the mercury salts more or less perfectly, the 
second only by blue mass and calomel, the third by the bichloride and 
biniodide of mercury. 

As an Antisyphilitic. — In syphilis mercury is to be given, not 
because the patient is in this or that stage of the disease, but because 
the conditions present call for its employment. Many writers have 

Fig. 49. 




Lamp for mercurial fumigations. This lamp is made of wire gauze, and resembles the safety 
lamp of miners, thereby guarding against sudden explosions of the alcoholic vapors. 



insisted that it ought only to be employed in the secondary stages, 
and while this is, as a general rule, correct, certain conditions may 
call for it at any time. 

Of all the preparations of mercury used in the treatment of syphilis, 
the protoiodide is the most popular, and deservedly so. (See article on 
Syphilis.) 

Mercury is often administered by means of fumigations or inhala- 
tions both for the removal of local and general syphilitic disorders. 
The best apparatus for either purpose is one devised by Bumstead, and 
it is both simple and inexpensive. It consists of a sheet-iron cup so 
bent that the bottom of the vessel, instead of being flat, projects up- 
ward into the centre of the cup, thereby forming a raised centre with 



320 



DRUGS. 



a little ditch about it. The top of this projection is flattened, and on 
its apex is placed the calomel which is to be sublimed. The surround- 
ing ditch is then filled with hot water, and the cup placed over an alcohol 
flame, which disengages the vapor of the calomel and water. (See 
Fig. 49.) 



Fig. 50. 




A patient prepared for the use of mercurial sublimations. A blanket having been pinned 
tightly around the neck after the patient is stripped, the fumigator shown at his feet is placed 
under his chair and the calomel placed on the central disc, as shown in the illustration. Water is 
in the little ditch around it and an alcohol lamp under it. The patient should be given a full, 
warm bath beforehand to cleanse and prepare the skin for absorption. 



When inhalations are used the face should be held some six or 
eight inches from the cup to permit the fumes to pass through the 
air. Under these circumstances the quantity of calomel used should 
not exceed 4 or 5 grains (0.25-0.30), and the mouth should be rinsed 
out to prevent mercurial stomatitis unless a local action on the buccal 
mucous membrane is desired. Not more than eight or ten inspira- 
tions should be taken at one sitting. 



MERCURY. 321 

If general fumigations are to be practised, the patient places the 
lamp and cup with 30 grains (2.0) of calomel on it under a chair, on 
which he sits wrapped in a heavy blanket, and subjects himself not 
only to these fumes, but to a home-made Russian bath, which relaxes 
his skin and aids absorption. (See Fig. 50.) 

I believe that the ultimate conclusion of the profession in regard 
to the hypodermic injection of mercurials in syphilis will certainly be 
identical with that governing this use of quinine in malarial fever. 
There can be no doubt that a certain number of instances do arise in 
which, by reason of severe infection, susceptibility of the patient, or 
inability to take mercury by the ordinary means, hypodermic injec- 
tions are absolutely necessary. In the same way that we give quinine 
by the mouth, the rectum, and hypodermically in pernicious malarial 
fever, so do we give mercury by the mouth, by inunctions, by sub- 
limation, and by the hypodermic needle in malignant syphilis. The 
reasons for believing that hypodermic injections of mercurials are not 
to be resorted to in the routine treatment of syphilis are several. In 
the first place, all forms of hypodermic medication possess disadvan- 
tages not possessed by the use of drugs by the mouth. There is always 
danger of entering a vein, of producing an abscess, or of causing local 
pain. When mercurials are so employed, the danger of abscess, of 
pain, or of milder inflammatory manifestations is greatly increased, 
and the presence of an indurated spot where the hypodermic injection 
has been given proves that it is not the best form of medication in 
syphilis. Of the mercurial preparations which may be administered 
hypodermically in syphilis, the two which surpass all others are un- 
doubtedly the bichloride of mercury, in the dose of J grain, dissolved 
in 10 or 15 minims of distilled water, every second or third day, and 
gray oil (Oleum Cinereum), which was first introduced into medicine 
by Lang, of Vienna. (See Gray Oil, under Mercury.) 

In all cases the injection should be given slowly and deeply into 
some portion of the body in which the tissues are loose, as the buttock 
or the broad of the back, and the skin of the part where the injection 
is to be made should be carefully washed and sterilized by the use of 
green soap and alcohol. 

The intravenous injection of bichloride of mercury has been proved 
so dangerous as to be properly considered unjustifiable. 

It is to be recalled that the herpes seen in advanced syphilitics is 
usually made worse by mercury. Also, that headache due to syphilis, 
if due to a cerebral growth, is benefited by mercury; while that due 
to ansemia and debility complicating syphilis is increased by this drug. 

As a Purge. — The employment of mercury as a purge or laxative 
having a special action on the liver is constantly resorted to. The two 
preparations used are blue mass and calomel, but the latter is more 
active. They both cause soft or watery stools, according to the dose in 
which they are given, but the blue mass is rarely, if ever, used except 
for the production of a laxative effect 

21 



322 DRUGS. 

Much discussion has arisen as to whether mercury affects the liver, 
and whether the peculiar greenish or brownish-yellow stools produced 
by it are due to the presence of bile or mercury. 

If there is one point firmly fixed in the mind of the average practi- 
tioner of medicine, it is that the mild chloride of mercury increases 
the quantity of bile in the intestine. If such a believer is questioned 
as to whether this increased amount of biliary fluid is due to a true 
increase in secretion or simply to an increase in the flow of bile from 
the gall-bladder, he will either state that he is unable to answer the 
question or that he believes that it is an increased secretion. 

Practically, the position of the profession in general in regard to 
the purgative influence of calomel is that the drug exercises a stim- 
ulating effect upon the biliary gland. Experimentation upon the lower 
animals by several competent observers, and studies made by physio- 
logical chemists, fail, however, to give much light upon this sub- 
ject. It is held by some that calomel never acts as calomel, but 
is converted by the hydrochloric acid of the gastric juice into cor- 
rosive sublimate, and that this drug then stimulates the liver to 
increased activity. On the other hand, the best chemical investigations 
show positively that the feeble acidity of the gastric juice and the 
temperature to which the calomel is exposed are not favorable to the 
conversion of a sufficient quantity of calomel into corrosive sublimate 
to account for any hepatic influence. Thus it was found by Ruther- 
ford and Vignal, in their well-known series of studies of the influence 
of drugs upon the secretion of bile, that if 5 grains (0.30) of calomel 
are subjected, at 100° F., for seventeen hours to the action of normal 
gastric juice, not more than -^ of a grain of mercuric chloride is 
produced. As calomel does not remain in the human stomach for 
more than a day at the utmost, and generally but a few hours, 
it is not likely that as much as -^ of a grain of mercuric chloride is 
produced from the moderately large dose of 5 grains (0.30). In con- 
tradiction of this, Bucheim, Winkler, and others assert that no con- 
version whatever takes place at the temperature of the body, and 
Jaennel's later studies support this view. 

The other theory as to the change which takes place in calomel 
prior to its action upon the liver is that it escapes into the intestines, 
where it is decomposed and the gray oxide of mercury precipitated, 
which may, however, be held in solution by any fatty materials, which, 
being mixed with alkaline liquids, practically form soaps. It is thought 
by Wood and others that this is the more probable result, particularly 
in view of the fact that calomel acts more like blue mass than cor- 
rosive sublimate. Further than this, these opinions are confirmed by 
the fact, with which all of us are familiar, that the hepatic influence 
of calomel is much more positively asserted if at the same time small 
doses of the bicarbonate of sodium are administered. Under these 
circumstances the bicarbonate of sodium naturally diminishes, to some 
extent at least, the acidity of the gastric contents, and also directly 



MERCURY. 323 

or indirectly tends to increase the alkalinity of the contents of the 
duodenum. 

As if to increase the complexity of the problem, the studies of 
Rutherford and Vignal seem to prove conclusively that, in the dog 
at least, mercuric chloride has a direct stimulant effect upon the 
hepatic cells; whereas calomel, while producing purgation by increas- 
ing the secretion of the intestinal glands, in no way increases the 
secretion of the bile; and this would seem to indicate that, after all, the 
influence of calomel upon the liver is due to a very minute portion 
of it being changed into corrosive sublimate. Probably the truth of 
the matter is, that we have as yet no definite scientific explanation of 
how calomel really does act. It may be that the solution of the problem 
lies in the hepatic influence exercised by the presence of minute quan- 
tities of corrosive sublimate, and the purgative effect produced by that 
portion of the calomel which has not been converted into the strong 
chloride of mercury. This is rendered the more likely in view of the 
fact that the corrosive sublimate has been found a feeble intestinal 
stimulant, while the calomel has been found to produce active purga- 
tion in dogs, without producing an increase in biliary flow, when the 
drug has been introduced into the duodenum. 

It has been suggested, too, that calomel itself may stimulate the 
bile-expelling mechanism, while the minute portion of corrosive sub- 
limate increases the secretion of the liquid; and, again, that by means 
of the purgative effect that it produces certain substances which have 
been in the intestine are immediately removed, and, as a consequence, 
a depressant influence upon the hepatic cells no longer exists. 

Quite a number of physicians have studied the effect of the various 
so-called cholagogue drugs upon the flow of bile in human beings who 
have had biliary fistula. Perhaps the best studies are those of Pfaff 
and Balch, and more recently those of Joslin, upon women with biliary 
fistula. Calomel and the bichloride of mercury seemed invariably in 
these cases to decrease rather than increase the biliary flow. Ox-gall 
was the only drug which did increase it. 

This subject also is of interest to the practical physician in rela- 
tion to the administration of calomel in compressed tablets or other 
preparations when mixed with what might be called excipients. Under 
these circumstances, if one of the excipients is bicarbonate of sodium 
the tablet after a time almost always undergoes a change and becomes 
of a gray color. Those who have used pills or tablets of calomel which 
have been kept for a long period of time seem to be universally in 
accord with the statement that they have lost the hepatic effect which 
a recently prepared powder always possesses. Thus it has been fre- 
quently found that no biliary flow occurs under the use of stale tablets, 
whereas free bilious purging follows the administration of freshly 
prepared powders. 

Calomel and blue mass are largely used in the condition known as 
biliousness, and undoubtedly give relief. (See Biliousness.) If the 



324 DRUGS. 

tongue is heavily coated, the breath foul, the conjunctiva a little 
icteroid, and headache is present, one of them should be employed. 
In remittent malarial fever the use of small repeated doses of calomel 
will often bring relief from the vomiting, and it should always be 
given in the treatment of malarial disease before quinine is used if 
a thorough action of the antiperiodic is required, as it aids in the 
absorption of the drug. 

As a Disinfectant. — The disinfectant and germicidal power of 
bichloride of mercury and of the biniodide is well established by 
clinical experience and experimental investigation. The strength of 
the bichloride in solution for antiseptic purposes may vary from 1 to 
2000 to 1 to 20,000 of water, and for disinfectant use from 1 to 500 
to 1 to 1000. (See Antiseptics.) 

In using the bichloride of mercury as an antiseptic it is necessary 
to add a few grains of tartaric acid to the solution to prevent its unit- 
ing with the albumin of the tissues to form an insoluble and useless 
albuminate. The same is true of the use of mercury biniodide. 

As an Antiphlogistic. — Formerly it was the belief of a large 
number of physicians that mercury possessed distinct antiphlogistic 
power in the early stages of acute sthenic inflammations, particularly 
if they involved serous membranes. It was the custom to administer 
full doses of calomel guarded with opium when traumatic meningitis 
was feared, and in endocarditis, pericarditis, pleuritis, and peritonitis 
its use was largely resorted to. More recently this plan of treatment 
has become almost obsolete, not because any deleterious effects have 
followed its use, but apparently as a matter of fashion. The writer 
believes that this is a mistake and that in acute inflammations in 
sthenic individuals in the early stages of disease mercury may do 
good. 

One of the best ways to employ all of the various forms of mer- 
cury is in the form of triturates, which may be prepared by triturating 
10 parts of the drug with 90 parts of milk-sugar. The minute sub- 
division of the medicament aids in its efficiency, because of its more 
ready absorption. 

Leaving the general subject of mercury, we may now consider each 
individual preparation. 

Ammoniated Mercury. 

White Precipitate, or Ammoniated Mercury of the strength of 10 
per cent, with lard (Hydrargyrum Ammoniatum, U. S. and B. P), is 
used in an ointment (Unguentum Hydrargyri Ammoniati, U. S. and 
B. P.) in various skin affections, when a stimulating application is 
needed, as, for example, in psoriasis and chronic dry eczema. It is also 
sometimes employed as a parasiticide in cases of tinea. The official 
ointment should generally be diluted with lard, as it is far too strong 
and will often induce a dermatitis if used undiluted. 



MERCURY. 325 

In ozcena, whether syphilitic or not, Trousseau has recommended the 
employment of the following powder as a snuff: 

1^ — Hydrargyri ammoniati gr. iv (0.25). 

Pulv. sacchar. alb ^ss(16.0). — M. 

S. — To be used as a snuff, after thoroughly blowing the nose. 

The red precipitate may be used instead of the white. The treat- 
ment removes the stench and may cure the complaint. It may, how- 
ever, irritate the mucous membrane, in which case it should be used in 
the strength of 2 grains to the J ounce (0.12-16.0). Ammoniated 
mercury is never used internally. 

Bichloride of Mercury. 

The Bichloride of Mercury, or Corrosive Sublimate (Hydrargyri 
Chloridum Corrosivum, U. S.; Hydrargyri Perchloridum, B. P.), as 
it is called, is an exceedingly poisonous and irritating substance when 
taken internally in concentrated form. 

Taken internally, it causes violent pain in the stomach, vomiting, 
purging of mucus, blood, and the contents of the intestine, collapse, 
syncope, and death. If taken in poisonous amount, the patient should 
be made to swallow large quantities of the antidote, white of egg, the 
stomach should be washed out with the stomach-pump, heat should 
be applied about the body, and the proper stimulants be given if 
the pulse or respiration fail. If death does not occur at once, the 
patient generally has a protracted convalescence or else dies from the 
organic changes produced in the gastro-intestinal tract, such as stric- 
tures, sloughs, destruction of the peptic glands, and ulcerations. 

Not only does the bichloride of mercury produce symptoms of acute 
poisoning when taken in large doses, but it is also capable of causing a 
form of subacute poisoning in those patients who have it applied too 
freely as an antiseptic wash or lotion. Particularly are these symptoms 
developed after intra-uterine or vaginal irrigations with bichloride 
solutions. The symptoms are abdominal pain, diarrhoea with tenes- 
mus, and finally sanguinolent discharges. There is also scanty urina- 
tion or the activity of the kidneys is entirely suppressed. Sometimes 
death comes rapidly and sometimes even the symptoms do not develop 
for several days after the drug is employed. 

The bichloride of mercury is an exceedingly useful preparation 
of mercury for hypodermic injection in syphilis, and is better than 
calomel for this purpose. About -g- grain (0.01) may be injected 
deeply and gently into the cellular tissues every two or three days. 
When the injections are made the greatest possible cleanliness should 
be obtained. The needle should be aseptic and the hands of the opera- 
tor well disinfected. The best place for the injection is in the gluteal 
region or between the shoulder-blades. 

Mercury bichloride, aside from its antiseptic use (see Antiseptics), 
is of great value when given internally, not only in syphilis, but in 



326 DRUGS. 

other states not associated with any such depraved condition, as in 
chronic contracted kidney. In diphtheria it may be used to prevent 
fibrinous exudation as readily as calomel (see Diphtheria), and in ton- 
sillitis, where the inflammation is severe, it is often used with great 
service. (See also Mercury Biniodide.) 

In small amounts — that is, in -fo to -J^ grain (0.001-0.0015) three 
times a day — the bichloride is one of the best remedies for the 
treatment of anaemia depending upon a deficient number of blood 
cells. If the anaemia is syphilitic in origin, it is, of course, peculiarly 
useful. 

Bichloride of mercury is of value in minute doses of -g-J-g- grain 
(0.0001) for the ill-smelling green stools of summer diarrhoeas in 
adults and children, and it has been recommended that a solution 
be made of \ grain (0.03) in 5 ounces (150.0) of water, and a tea- 
spoonful given every hour until relief is obtained. The water used 
in making the solution should be distilled, and it may be well to add 
to it a little tartaric acid to prevent precipitation of the bichloride by 
organic matter which may have gotten into the water. This treat- 
ment is particularly useful in mucous diarrhoea in which blood and 
mucus are thoroughly mixed. Patients in the dispensaries often speak 
of these passages as containing "corruption/' and others think they 
consist of "lumps of flesh," owing to the masses of blood and mucus. 
Whether the disease be acute or chronic, the bichloride, used in the 
way just described, will be found of service. In dysentery and the 
diarrhoea of adults the same treatment may be resorted to, using 2 
teaspoonfuls of the solution instead of 1. It is hardly necessary to add 
that the greatest care must be bestowed upon the diet and clothing. 
The author has treated a child suffering from persistent diarrhoea for 
months with varying success, only to succeed when, it being found 
that the abdomen was exposed to the air, the mother was forced to 
apply and keep on the child a flannel binder. 

In some cases in which an obstinate syphiloderm is present. \ 
ounce (16.0) of corrosive sublimate and 1 ounce (30.0) of chloride of 
ammonium may be added to a warm bath, which should be taken 
every few days. One-half a grain (0.03) of the bichloride of mer- 
cury in 6 ounces (180.0) of water is said to be most efficient as 
an injection in gleet, if used every three or four hours. (See Gonor- 
rhoea.) 

In all parasitic affections of the skin a solution of 2 grains (0.12) 
of bichloride to the ounce (30.0) of water may be sopped on the part 
three times a day. A solution of perchloride of mercury (Liquor 
Hydrargyri Perchloridi) is official in the B. P.; it is prepared by add- 
ing \ grain (0.03) of the perchloride of mercury to 1 ounce (30.0) of 
water, with \ grain (0.03) of ammonium chloride to hold it in solu- 
tion. 

(For the antiseptic uses of the bichloride of mercury see Antiseptics 
and Disinfectants.) 



MERCURY. 327 



Biniodide of Mercury. 

Mercury Biniodide (Hydrargyri Iodidum Rubrum, U. S. and B. P.) 
is a bright-red powder, possessing irritant powers equal to or greater 
than those of the bichloride, and causing symptoms, when taken in over- 
dose, closely resembling those produced by the latter drug. Owing 
to the formation of the salt, it is thought to be particularly useful 
in the later stages of syphilis. The dose is -^ to -^ grain (0 002- 
0.004). (See Syphilis.) An ointment (Unguentum Hydrargyri Iodidi 
Rubri, B. P.) is useful as an application in goitre and obstinate skin 
diseases. In the dose of -^-q grain every hour for 4 or 6 doses this drug 
is a most useful remedy to abort acute tonsillitis. 

At one time it was thought that biniodide of mercury was a better 
antiseptic than the bichloride, but recent researches have proved that 
this is not a fact. 

Black Wash. 

Black Wash (Lotio Hydrargyri Nigra, B. P.) is made by adding 
1 drachm of calomel to a pint (4.0:480 c.c.) of lime-water. It is used 
as a stimulant, application for washing syphilitic sores and wounds 
in various forms of eczema. 

Blue Mass. 

Blue Mass (Massa Hydrargyri, U. S.; Pilula Hydrargyri, B. P.) 
is made by rubbing up metallic mercury with liquorice and other 
excipients, and is often called Blue Pill. Each grain of the mass con- 
tains J grain (0.02) of mercury, and it may be given in the dose of 
from \ to 20 grains (0.03-1.3) for the same laxative purposes for which 
calomel is used. Blue mass is rarely employed to produce systemic 
effects. 

Calomel. 

Calomel (Hydrargyri Chloridum Mite, U. S.; Hydrargyri Subchlo- 
ridum, B. P.), or the Mild Chloride of Mercury, is an insoluble salt 
which is, nevertheless, freely absorbed. 

Calomel when used as a laxative purge should be given in the dose 
of \ to \ grain (0.01-0.03) every half-hour or every fifteen minutes until 
1 or 2 grains (0.06-0.1) are taken, as it will often act as efficiently in 
this way as if 10 grains (0.60) are given at one dose, and there is no 
danger of producing ptyalism. The reason that small doses are as 
efficient as large ones lies in the fact that only the calomel which is 
changed into the gray oxide is active, and, as the amount of alkaline 
juice in the intestine is small, only a minor part of a large dose of 
calomel acts, the major portion escaping unchanged. This is the 
reason that bicarbonate of sodium is added to calomel powders, to aid 
the intestinal juice in the reduction of the salt. While this statement 
is true of the use of calomel in temperate climates, it does not hold 



328 DRUGS. 

good in hot climates, where much larger doses, amounting to 10 (0.60) 
or even 20 grains (1.3) are often given to affect the flow of bile, the 
hepatic gland being made torpid by heat. If purgation does not occur 
after a full dose of calomel, a saline purge must be given at the end 
of the twenty-four hours, and this must always be used if large doses 
of the mercurial are employed, to avoid possible mercurialization. 

Mercury in the form of calomel has been used hypodermically in 
the treatment of syphilis, being held in solution by a mucilage. Best 
of all, however, is the employment of chloride of sodium in water with 
the calomel, in the proportion of 5 parts each to 50 parts of water. 
It should be injected deeply into the tissues, not immediately under- 
neath the skin, the greatest cleanliness being necessary to avoid 
abscesses. The best place for these injections is in the fold of the 
buttocks, but sloughing, tetanus, and even gangrene, have followed its 
employment in this way. (See also Salicylate of Mercury and Bichlo- 
ride of Mercury and Gray Oil.) 

In dysentery of the acute form calomel and ipecac are valuable 
remedies. (See Dysentery and Ipecac.) The calomel should be given 
in small doses, repeated every hour or half-hour until a favorable 
change in the number and character of the stools appears. Calomel 
is not to be used if great asthenia complicates the disease. 

In children who seem constantly " under the weather" and never 
quite well, who have flatulence, fetid breath, and ill-smelling, pasty 
stools, calomel often gives great relief in the dose of 2V grain (0.003) 
every half-hour until four doses are taken, this treatment being pur- 
sued every fourth or fifth morning. 

In jaundice due to exposure to cold and to slight hepatic conges- 
tion J grain (0.01) of calomel every half -hour until 1 grain (0.06) is 
taken will often bring relief. 

Calomel is generally prescribed in conjunction with sugar of milk, 
white sugar, or bicarbonate of sodium, which are added to increase 
the bulk and wieldiness of the powder, and, in the case of the latter 
ingredient, to increase its activity. Owing to its lack of taste, calomel 
is often placed on the tongue in children, and for this class of patients 
white sugar is to be used in small quantity, as the other vehicles are 
less agreeable. The most pleasant form of administration is by means 
of triturates. These should not be compressed. 

It is important to remember that calomel when used as an anti- 
syphilitic produces salivation much earlier than the other mercurials. 

Sometimes calomel is of value when dusted into the eye in cases 
of phlyctenular conjunctivitis which are strumous. This practice 
must not be resorted to if iodine or iodides are being taken internally, 
as the iodine is eliminated by the tears and forms a compound which 
burns the conjunctiva. 

A very important use of calomel and one which has been brought 
forward very recently as new, but which is really many years old, is 
its employment in dropsy as a diuretic, either alone or combined with 



MEHCUBY. 329 

squills or digitalis, or with opium to prevent purging. The dose is 
small, about 1 grain (0.06) thrice a day, and if a diuretic influence 
does not assert itself in forty-eight hours it should not be continued. 
How calomel acts to produce the increased urinary flow under these 
circumstances is not known. Some suppose that it aids the absorption 
of liquid from dropsical tissues, and so increases urinary secretion; 
others think that it stimulates the renal epithelium to greater activity. 
The latter view seems the least probable of the two, but neither 
theory has been proved correct, although experimentation supports 
the view first named. The full urinary effect of the drug is not felt 
till the second or third day of its use, and speedily passes away, par- 
ticularly as purging is often induced very early. Still another use 
of calomel is in typhoid fever, in which disease it has been highly 
recommended in small repeated doses, particularly if constipation is 
present. In the opinion of the author this is disadvantageous as a 
routine measure and entirely uncalled for, although in the very early 
stages of the disease, when the bowels are confined and the tongue 
coated, a dose of 1 grain (0.06) in fourths with a little bicarbonate 
of sodium is useful. 

Sydney Ringer has called attention to the fact that in constipation 
or in "biliousness" podophyllin does more good than calomel, pro- 
vided that the stools are dark in color, whereas if the same signs are 
present, but the stools light and clayey in color, calomel is more efficient. 
The author has proved the correctness of this assertion so frequently 
that he is convinced of its truth. 

Calomel has been recommended in the condition of anorexia and 
depression following acute diseases, and when the tongue is covered 
by a thick yellow coat it is the remedy for the gastro-intestinal torpor 
always present. While purgative doses of calomel certainly are of value, 
the use of freshly-prepared nitromuriatic acid is, however, highly prefer- 
able to the mercurial salt in many such instances. Both of these drugs 
should not be given simultaneously, because they are incompatible. 

Calomel is often given in small doses to " settle the stomach." 
Sometimes it will act in this way, but in other cases it will seem to 
increase the nausea and bring on vomiting. This is true of both adults 
and children, and it is impossible to tell beforehand which will occur. 
Ringer asserts that in a peculiar form of vomiting occurring in very 
young children, which comes on immediately after the food is swallowed 
the rejection of milk being forcible, and perhaps so sudden that it is 
not even curdled, and which is not accompanied by much straining, 
calomel will often give relief when all other remedies fail. It should 
not be resorted to until some evidences of wasting occur, as this action 
of the stomach in many children only rids that organ of that part of 
the milk which is in excess, and is a purely physiological regurgitation. 
The calomel may be given in the dose of y^ grain (0.005) every hour, 
or, if preferred, gray powder in the dose of J grain (0.02) every hour 
for three doses, is equally efficient in these cases. 



330 DRUGS. 

Calomel in a fine powder will often remove syphilitic condylomata 
if dusted over them for some time, and an ointment made of 1 drachm 
(4.0) of calomel to 1 ounce (30.0) of lard is very useful in pruritus ani. 

The B. P. contains a pill mass of calomel, called Pilula Hydrargyri 
Subchloridi Composita, which contains antimony, guaiac resin, and 
castor oil. Its dose is 2 to 8 grains (0.12-0.5). 

Calomel ointment (Unguentum Hydrargyri Subchloridi, B. P.) is 
often useful in the treatment of small patches of eczema, or the fol- 
lowing prescription may be given for its use: 

1^ — Hydrarg. chlor. mit gr. xl (2.60). 

Magnesiae carbonatis gr. xl (2.60). 

Unguent, aquae rosse §j (30.0). — M. 

Gray Oil. 

Gray Oil {Oleum Cinereum) is prepared as follows: 2 drachms 
(8.0) of lanolin are rubbed up with sufficient chloroform to emulsify it. 
The rubbing process is continued until most of the chloroform is 
evaporated, and while the mixture is still in a fluid state metallic 
mercury, in double the amount of lanolin, 4 drachms (16.0), is added 
and the trituration continued. By this means an ointment of mercury 
is left which equals 2 parts of mercury and 1 of lanolin. This is some- 
times called Strong Gray Ointment. For hypodermic injection 3 
parts of this gray ointment are added to 1 part of olive oil, or it may 
be still further diluted by adding olive oil in the proportion of half- 
and-half. Of this mixture 1 to 2 minims (0.05-0.1) may be injected 
every second or third day. 

By some practitioners this preparation is considered much better 
than any other for hypodermic use in syphilis. 

Mercury with Chalk. 

Mercury with Chalk {Hydrargyrum cum Creta, U. S. and B. P.), 
or Gray Powder, is slightly purgative, but is chiefly employed in the 
treatment of infantile syphilis, as it will not freely purge. It is com- 
posed of 38 parts of mercury, 12 parts of sugar of milk, and 50 parts 
of prepared chalk. The dose is 1 to 10 grains (0.06-0.60). Children 
suffering from syphilitic marasmus seem fairly to fatten on it. This 
preparation is also of service in the syphilis of adults, and may be 
employed whenever the laxative effect of mercury is not desired. 

In the treatment of infantile diarrhea with watery, colorless stools 
containing undigested food gray powder in small doses is often very 
useful. 

Mercury Ointment. 

The Ointment of Mercury, Mercurial Ointment {Unguentum 
Hydrargyri, U. S. and B. P.), sometimes called Blue Ointment, is 
made by rubbing up mercury with suet and lard until the mercury is 



MERCURY. 331 

extinguished, or, in other words, until the globules of mercury cannot 
be seen with a magnifying power of ten diameters. A dilute ointment 
of mercury (Unguentum Hydrargyri Dilutum, U. S.) containing 67 
parts of mercury ointment in 100 is also official. 

The ointment of mercury is used externally in skin affections and 
for the purpose of influencing the general system. In syphilis where 
a mercurial effect is to be reached the ointment in small amounts 
should be thoroughly rubbed into the skin in various parts of the 
body — one evening in the left groin, the next evening in the right 
groin, the following evening in the left axilla, and the fourth evening 
in the right axilla, beginning on the fifth evening in the left groin 
once more. This avoids local irritation of the skin by too frequent 
applications, places the drug on spots where it is readily absorbed, 
and rapidly influences the system of the patient. In infantile syphilis 
this method may be employed, or a flannel binder covered with the 
ointment may be placed about the belly. The clothes should not be 
changed too frequently, as their saturation with the drug aids in pro- 
ducing the impression upon the system, and the wearing of an under- 
shirt saturated with the ointment is a valuable, though somewhat dirty, 
method of producing mercurialization. 

The ointment of mercury is sometimes rubbed into the skin over 
enlarged glands. 

Under the name of Oleate of Mercury (Oleatum Hydrargyri, U. S. ; 
Hydrargyri Oleas, B. P.) a very efficient and more agreeable appli- 
cation than the ointment is used in its place or still further diluted 
with lard, when it becomes the Unguentum Hydrargyri Oleatis, B. P. 
It is made from the yellow oxide of mercury. (See Oxides of Mercury.) 

For pediculus pubis, or in any case where parasites, such as the 
flea or louse, infest the region of the genitals or any spot covered by 
a hairy growth, mercurial ointment may be used as a remedy, owing 
to its lethal influence over these pests. Care should be taken that 
it does not cause salivation of the patient, and it must not be allowed 
to remain on the parts, but be wiped off in the course of an hour or 
two or less. The following words of Dr. Joseph Leidy are suffi- 
ciently interesting to demand a place at this juncture: "We may 
here say that if it is once understood that all insects, including lice, 
are destroyed quickly by the application of any fixed or volatile oil, 
physicians will see there is no necessity of employing remedies of 
a noxious character to the patient. The fat of mercurial ointment 
is probably more active than the mercury itself." 

Linimentum Hydrargyri, B. P., and Emplastrum Hydrargyri, 
U. S. and B. P., are used for the same purposes as is the ointment 
of mercury. The plaster is made with olive oil, resin, and lead plaster 
instead of ordinary suet or lard. 

Nitrate of Mercury. 

The solution of Mercuric Nitrate (Liquor Hydrargyri Nitratis, 
U. S., and Liquor Hydrargyri Nitratis Acidus, B. P.), Acid Nitrate 



332 DRUGS. 

of Mercury, is an exceedingly active, penetrating caustic, so rapid in 
its effects that it seems to drop through the tissues. It may be em- 
ployed for the removal of epitheliomata and large warts, and should 
be applied by means of a glass rod. This treatment may also be 
resorted to with advantage in lupus until the surface of the growth is 
level with the skin. The surrounding parts should be protected by 
lard or oil. As this treatment is very painful, the spot may be first 
cocainized and afterward covered with flexible collodion. 

Citrine Ointment (Unguentum Hydrargyri Nitratis, U. S. and 
B. P.) is used as a stimulating application in cases of chronic skin 
diseases of the scalp and trunk. It is too strong for ordinary use, 
and should be diluted one-half or less with lard according to the stim- 
ulating effect required; the dilute ointment is official in the B. P. as 
Unguentum Hydrargyri Nitratis Dilutum. 

Oxides of Mercury. 

The Yellow and the Red Oxide of Mercury (Hydrargyri Oxidum 
Flavum, U. S. and B. P., and Hydrargyri Oxidum Rubrum, U. S. 
and B. P.), Red Precipitate, are used largely as a dressing for syph- 
ilitic sores when diluted about one-half with chalk or other powder. 
If used pure, they are somewhat caustic. From the yellow oxide is 
made the Oleate of Mercury (Oleatum Hydrargyri, U. S.), which is 
used for the same purpose as ordinary mercurial ointment. 

In intestinal and gastric indigestion, with foul belching and very 
ill-smelling stools which are due to intestinal fermentation, the yellow 
oxide is sometimes given in the dose of -g 1 ^- to ^ grain (0.001-0.0012) 
in a triturate. 

Red Precipitate Ointment (Unguentum Hydrargyri Oxidi Rubri, 
U. S. and B. P.) and the Ointment of the Yellow Oxide (Unguentum 
Hydrargyri Oxidi Flavi, U. S. and B. P.) are largely used, diluted 
one-half with lard, for chronic scaly skin affections, in obstinate con- 
junctivitis, and in granular lids and styes. (See Styes.) They should 
always be freshly prepared. 

Protiodide of Mercury. 

Mercury Protiodide (Hydrargyri Iodidum Flavum, U. S.) is much 
more mild than the biniodide, and is given for exactly the same pur- 
poses. It is very useful in chronic Brighfs disease. It is to be remem- 
bered as the best mercurial preparation for ordinary cases of secondary 
syphilis. (See Syphilis, Part IV.) It should be given in ascending 
doses. The dose is J to | grain (0.01-0.015) three times a day. 

Salicylate of Mercury. 

Salicylate of Mercury is a drug which has come into quite general 
use since the introduction of the hypodermic method of administer- 



METHYL BLUE. 333 

ing mercury in syphilis. It is to be suspended in paraffin oil in the 
proportion of 22 grains (1.5) of the salicylate of mercury to 3 drachms 
(12.0) of the oil, and before it is used the bottle must be well shaken 
in order that the insoluble mercury may not remain at the bottom. 
It is of great importance that the needle and syringe shall be thor- 
oughly cleansed after each injection, as the insoluble drug readily 
clogs the instrument. At first 1 minim (0.05) of the mixture just 
named should be injected deeply into the gluteal region every fourth 
day, and this may be increased to every second day if no systemic 
evidences of the action of the drug appear. 

Yellow Sulphate of Mercury. 

Hydrargyri Subsulphas Flavus has been used under the name of Tur- 
peth Mineral as an irritant in chronic ophthalmia and also as a prompt 
emetic in croup. It is a quick and certain emetic, and, it is claimed, 
does not produce depression, but the writer would recommend great 
care in its use. The dose for a two-year-old child is 2 to 5 grains 
(0.12-0.30), repeated in fifteen minutes if necessary. 

If as much as 5 grains (0.30) has been given, and emesis does not 
follow, other emetics or the stomach-pump must be used to prevent 
gastro-intestinal irritation. 

Yellow Wash. 

Yellow Wash (Lotio Hydrargyri Flava, B. P.) is made by adding 
30 grains (2.0) of corrosive sublimate to a pint (480 c.c.) of lime-water. 
It is used for the same purposes as the black wash already mentioned, 
but is much more stimulating. 

Incompatibles. — Bichloride of mercury should never be given with 
any other substance except iodide of potassium and chloride of ammo- 
nium, as it is incompatible with almost every other drug. With the 
iodide of potassium it may be used because the precipitate formed is 
at once redissolved and the resulting mixture is highly alterative. 

Calomel should never be given with iodides or bromides, and hydro- 
chloric acid may convert it into the bichloride if the acid is present in 
any amount. It is also incompatible with antipyrin. 



METHYL BLUE. 

Methyl Blue, or Methyl Violet, is an aniline dye often sold under 
the name of Pyoktanin. When used medicinally, it must be perfectly 
pure and deprived of its usual contaminating matter, arsenic, which if 
present causes local irritation of the part to which it is applied. Pyok- 
tanin was introduced to professional notice under this name by Still- 
ing as an antiseptic, but careful study has proved it to possess but 



334 DRUGS. 

feeble power over the growth of germs. In all conditions of the eye 
in which antiseptic lotions are indicated pyoktanin has been stated to 
be of value, but elsewhere in surgery it is practically useless as an 
antiseptic. Even in the eye it possesses, according to de Schweinitz, 
a limited range of usefulness, being no better than the older 
antiseptics, except in diseases of the lachrymal apparatus. The fact 
that pyoktanin stains everything it touches is a great disadvantage in 
its use. It may be tried in blepharitis, eczema of the eyelids, conjunc- 
tivitis, both simple and phlyctenular, and in the treatment of corneal 
ulcer. When so employed, it should be applied in the strength of 1 to 
1000 of water. 

It should be remembered that any pure aniline dye may be used 
in place of pyoktanin. Thus some physicians have used yellow pyok- 
tanin or auranine. 

Methyl blue and similar aniline substances have been largely 
employed by some physicians in the treatment of malignant neoplasms. 
The solution (1 to 500 of water) should be filtered through hot asbestos 
to render it sterile, and every antiseptic precaution carefully observed 
in giving the injection. The dose is J to 3 drachms (2.0-12.0) of 
this solution every other day or every third day, and the injection is 
to be given either into the growth itself if it is large, or just at its side, 
in the healthy tissues, if it is small. Too much should not be injected 
into one spot lest it cause a slough. This treatment does not cure 
the disease. It relieves pain and so quiets the patient, and in rare 
cases checks the growth of the tumor. If the growth sloughs, com- 
plete antiseptic dressing is necessary. An antiseptic pyoktanin-gauze 
dressing should always be used while the treatment is under way. 



METHYL CHLORIDE. 

Methyl Chloride is a colorless gas, easily liquefied under pressure, 
with an odor resembling that of ether and chloroform, and is used to 
produce local anaesthesia, which it does by absorbing a large amount of 
heat on passing from the liquid to the volatile state as it strikes the skin. 
It is usually kept in a small flask which has its open end covered by 
a metal cap. When this cap is removed the heat of the hand volatilizes 
the drug, which is then forced out of the flask in a fine spray. The 
nozzle should be held ten to twelve inches from the part to be frozen. 
Before the spray is used the skin of the part to be anaesthetized should 
be washed with soap and ether to remove all fatty substances. 

Under these circumstances the skin becomes pale in a few seconds, 
and afterward white and parchment-like in appearance. Local 
anaesthesia is now complete, and minor surgical operations, such 
as opening boils or abscesses, can be performed without pain. The 
spray should not be continued more than two to four minutes, as local 
death of the tissues may result. Advantages of the spray of methyl 



METHYLENE BLUE, 335 

over that of ether are its slight inflammability and rapidity of action. 
Methyl chloride should not be confounded with methylene chloride. 
The first is monochlormethane, the second dichlormethane. 



METHYLENE BLUE. 

Methylene Blue (Methylthionince Hydrochloridum, U. S.) is to be 
distinctly separated in the mind of the student from methyl blue, 
which is practically what is known by the trade name of " Pyoktanin." 
The latter ought not to be used internally. The methylene blue can 
be distinguished from methyl blue by this test: With sodium hydroxide 
methyl blue gives a purplish red, while methylene blue turns a deep 
violet. Also when a solution of the former is made in a test-tube the 
meniscus is blue, whereas with methylene blue it is greenish. 

Methylene blue has been employed in the treatment of malignant 
growths and in malarial fevers with asserted success, although its 
successful use in the first group of cases is decidedly problematical. 
When used in the treatment of sarcoma and cancer, from ^ to 2 grains 
(0.03-0.12) in watery solution are injected daily or on alternate 
days directly into the growth. The neoplasm, it is said, ceases to 
grow, shrinks, and comes away, leaving a fairly healthy sloughing 
surface. 

This treatment is so uncertain that it should only be tried in inoper- 
able cases, and in this class of patients its local use often seems to 
relieve the pain and check the fetor. 

In malarial fever of the intermittent type methylene blue seems 
to possess distinct curative powers. It is not so powerful as qui- 
nine by any means, but has its chief sphere of usefulness in patients 
who cannot take quinine or where quinine has been tried unsuccess- 
fully. This antimalarial influence is due to its destruction of the 
plasmodium malaria?, but its administration must begin from seven 
to ten hours before the expected intermittent paroxysm and be con- 
tinued after the attacks have ceased and for some little time after 
the physician fails to find the micro-organism in the blood, as relapses 
are common. Particularly good results seem to follow the use of 
methylene blue in children suffering from malaria. Untoward symp- 
toms from its use are not common, but when they do occur consist 
in slight vertigo, nausea, and some strangury, which latter symptom 
can be prevented to a great extent if powdered nutmeg (equal parts) 
is given simultaneously. The urine is always blue from the elimination 
of the drug through the kidneys. 

Recently Levy has employed methylene blue in the dose of from 1 
to 2 grains (0.06-0.12) four times a day in the treatment of migraine. 
It is to be given in capsule with kola. He states that as much as 15 
grains (1.0) may be given in a day with safety. 

Methylene blue has been highly recommended by Horwitz in the 



336 DRUGS. 

treatment of the earlier stages of gonorrhoea, as it shortens the course 
of the disease. He suggests the following formula: 

Methylene blue 2 grains (0 12). 

Oil of sandalwood 3 " (0.2). 

Oleo-resin of copaiba 3 " (0.2). 

Oil of cinnamon 1 minim (0.05). 

To be made in one capsule, three of which are to be taken each day. 

Injected into a muscle in the dose of 1 grain in 10 minims of water, 
methylene blue is used to test the activity of the eliminative function 
of the kidneys. In health it should appear in the urine in fifteen to 
thirty minutes, and persist for thirty-six hours. 

. When the kidneys are healthy the same test may be made to deter- 
mine whether an effusion in the pleural cavity or peritoneum is capable 
of being absorbed as a result of purgation. From 1 to 3 grains 
in solution are injected into the fluid in the chest, or abdomen, and 
a purge given. If the blue does not appear in the urine, this fact 
shows that absorption from the pleura has not occurred, because the 
lymphatics are blocked by inflammatory exudate. 

The ordinary dose in the treatment of malaria is 2 to 4 grains 
(0.12-0.25) every four hours to adults, or 1 to 2 grains (0.06-0.12) to 
children of five years, preferably given in capsule. 



METHYLENE CHLORIDE. 

Methylene Chloride is made from chloroform or by the action of 
chlorine on marsh-gas, and is a colorless liquid resembling chloroform 
in odor. It is readily decomposed by light, which change may be 
hindered by the addition of a little absolute alcohol. 

Therapeutics. — Methylene chloride is employed as an anaesthetic in 
a manner like chloroform, and was introduced as a substitute for 
that drug, but is of doubtful safety and is little used. It has been 
used as a spray for the production of local anaesthesia. As stated 
under Methyl Chloride, it is not to be confounded with that drug. 

In England, under the name of methylene chloride or methylene, 
a mixture of ethyl and methylene chloride has been widely employed 
by inhalation as an anaesthetic. This preparation is, of course, to be 
distinguished from true methylene chloride. The amount of this mix- 
ture used to produce anaesthesia is 1 to 2 drachms (4.0-8.0) for minor 
and 3 to 6 drachms (12.0-24.0) for major operations. The term 
"methylene chloride" has also been applied to a mixture of chloroform 
and methyl chloride. 

MUSK. 

Musk (Moschus, U. S. and B. P.) is obtained from the preputial 
follicles of Moschus moschiferus, or musk deer of Thibet, and is a 



MUSTARD. 337 

substance possessing remarkably penetrating powers, so far as odor 
is concerned. Very little of the musk for sale in the shops is pure, 
and most of it is not musk at all. Its price varies greatly, but if 
sold for less than twenty-five cents a grain it is probably worthless 
or impure. 

Therapeutics. — For some unknown reason musk acts as a diffusible 
stimulant and supports the system. It is also an antispasmodic and 
nervous sedative. In all low fevers where the strength of the patient 
is fast ebbing and the nervous symptoms are those of the most 
advanced depression, rectal injections of musk in starch-water may 
be employed. The dose should be 5 to 10 grains '(0.30-0.60). This 
drug is of value where either nervous excitement or nervous collapse 
is present, but is not to be employed until it is absolutely needed to 
carry the patient past a crisis. If frequently employed, it loses its 
power and the expense is a needless one. 

Musk is one of the best remedies in obstinate hiccough. 

The dose of the tincture (Tinctura Moschi, U. S.) is 40 minims to 
1 drachm (2.0-4.0), and of musk itself 5 to 10 grains (0.30-0.60). 



MUSTARD. 

Mustard is official in the form of Sinapis alba, U. S., and Sinapis 
AlboB Semina, B. P., or white mustard, derived from the seeds of 
Sinapis alba, and Sinapis nigra, U. S., and Sinapis Nigra" Semina, 
B. P., or black mustard, derived from the seeds of Brassica nigra. 
Both of these contain an irritant oil (Oleum Sinapis Volatile, U. S. and 
B. P.) as their chief active constituent. 

Therapeutics. — Mustard is often used in the form of mustard flour 
as an emetic when stirred in water in the proportion of 2 table- 
spoonfuls to a glass of water. It is also employed as a counterirritant 
and as a condiment. If given in excessive dose, it will cause violent 
gastritis, and chronic gastritis is often set up by its constant use in 
excess. Its internal use is contraindicated during the existence of 
acute gastritis and all states of gastro-intestinal irritation. 

When used as a counterirritant mustard is applied to relieve the 
pain of colic due to flatulence and acute inflammation of the abdominal 
and thoracic viscera, that due to muscular rheumatism, inflamed joints, 
and neuralgia, and it may be applied at the nape of the neck in cases 
of headache and cerebral congestion. When applied to the skin of an 
ordinary individual, it will produce a severe burn if left on more 
than a few minutes, and it should be mixed with wheat flour in 
the proportion of half-and-half when used upon tender skins. 
Children generally will not tolerate more than one-fourth mustard. 
The plaster should be made by mixing mustard flour and wheat flour 
together and then moistening the mixed flours with warm water or 
warm vinegar, or a little brandy may be used. 

22 



338 DRUGS. 

The scald or burn produced by mustard is peculiar in its slowness 
to heal and in the fact that it is tender and reddened for days. Often 
it produces a permanent stain of the skin. If the burning of the mus- 
tard becomes excessive, it should be treated by applying a piece of 
lint soaked in lime-water and olive oil, half-and-half, or olive oil alone 
may be used. 

The oil of mustard is very irritant, and almost epispastic in its 
effects. It is sometimes given in the treatment of the atonic stomach of 
drunkards in the dose of \ to \ minim (0.015-0.03). Charta Sinapis, 
U. S. and B. P., or mustard-papers, are sometimes called sinapisma, 
and these afford a ready means of applying this counterirritant. 
They are generally very strong, and one or two layers of thin and 
moistened linen should be placed between the skin and the sinapism to 
prevent too great an action. (See Counterirritation.) The compound 
liniment (Linimentum Sinapis Compositum; Linimentum Sinapis, 
B. P.) is composed of the oil of mustard, castor oil, extract of meze- 
reum, and alcohol. The mezereum is omitted in the British prepara- 
tion, which is twice as strong in mustard oil as that used in the 
United States. 

MYRRH. 

Myrrha, U. S. and B. P., is a gum-resin obtained from Commiphora 
myrrha, a tree of Arabia. It occurs in dark-colored tears, and contains 
an active principle, myrrhin. 

Therapeutics. — Myrrh, in medicinal amount, is a stimulant to the 
circulation and to the uterine and the bronchial mucous membranes. 

In amenorrhea due to functional inactivity or anemia, "iron and 
myrrh" is a standard remedy. 

The tincture of myrrh, diluted one-half, is useful in ulcerated sore 
throat as a gargle, and the pure tincture is sometimes applied with a 
small brush or by the end of the finger to spongy or tender gums. 

In leucorrhcea depending upon uterine trouble and in chronic cystitis 
myrrh is often of service. Sometimes it enters into expectorant mixtures 
given in the later stages of bronchitis. The dose of the tincture (Tine- 
tura Myrrhoe, U. S. and B. P.) is 10 to 30 minims (0.60-2.0). It also 
enters into the* composition of Pilule Aloes et Myrrhe, U. S. and B. P., 
dose two to five pills, and Tinctura Aloes et Myrrhe, U. S., the dose of 
which is 1 to 2 fluidrachms (4.0-8.0). 



NAPHTHALIN, or NAPHTALENE. 

Naphthalenum, U. S., is a coal-tar derivative occurring in color- 
less mica-like crystals, possessing a peculiar smell, and soluble in 
alcohol to some slight extent. Helbing states that naphthalin when 
pure is colorless and without action on moist litmus-paper. It should 



NARGOL. 339 

also dissolve without color in concentrated sulphuric acid when gently 
warmed. After it is taken for some time, or even after the first dose, 
the patient will state that when he belches the gas has the smell and 
taste of burning rubber. 

The drug possesses distinct antiseptic power, and for this reason 
has been employed in certain gastric and intestinal diseases asso- 
ciated with fermentative changes or dependent upon ulceration and 
organic lesions. In fetid diarrhoea it may be given as a deodorant and 
cure. 

When given to children, as in summer diarrhea, the dose should 
be \ to \ grain (0.01-0.015) every two or four hours, but adults may 
take as much as 5 to 10 grains (0.30-0.60). More than this will dis- 
order the stomach. The drug should be given in powder, with sugar, 
or in capsule. It has not been so widely employed as was expected 
when it first came to the notice of the profession, and certainly often 
fails to do good. 

In cats and rabbits naphthalin, when administered continuously for 
a considerable period of time, produces cataract. 



NAPHTOL. 

Beta-naphthol, U. S., and Naphthol, B. P., is generally prepared 
from naphthalin. It is used externally in antiseptic dressings. Intern- 
ally it is an excellent remedy for gastric fermentation and flatulence, 
as it acts as an active antiseptic. It is also useful in fetid diarrhoea of 
the serous type. The dose is 2 to 5 grains (0.12-0.3) in capsule or 
cachet. 

Beta-naphtol-bismuth, or Orphol, is a neutral, odorless, and tasteless 
powder designed to combine the sedative effects of bismuth with the 
antiseptic properties of beta-naphtol. It is used in cases of serous and 
fermentative diarrhoea in adults in the dose of 5 to 15 grains (0.3-1.0) 
and in infants in the dose of 2 to 5 grains (0.12-0.3) every few hours 
in capsule. 

Benzonaphtol is used as a substitute for beta-naphtol in fermentative 
dyspepsia. The dose is about 10 grains (0.60) three times a day, and 
it is best given in cachet. 

NARGOL. 

Nargol is a chemical compound of silver and nucleinic acid, which 
is readily soluble in water, and possesses a more penetrating power 
and more lasting effects than other silver preparations. It is not pre- 
cipitated by coming in contact with albuminoids, and it does not 
undergo change when boiled. Nargol contains about 10 per cent, 
of metallic silver, which is more than that contained in the other 
organic silver compounds now obtainable by physicians. 



340 DRUGS. 

Therapeutics. — Nargol is employed in the treatment of gonorrhoea 
in the form of injections in the strength of 0.25 to 1 per cent.; although 
in chronic cases the strength may be increased up to 5 per cent. It 
destroys the gonococcus, seems to penetrate into the crypts and 
deeper-lying tissues, and is said to produce little or no pain if not in 
too strong solution. It diminishes the discharge quite rapidly. 

By ophthalmologists it is employed in the strength of 5 per cent, 
in the treatment of the various inflammations of the conjunctiva, but 
is not sufficiently strong for granular conjunctivitis. It is, how- 
ever, a valuable drug in gonorrheal ophthalmia and in ophthalmia 
neonatorum. It has also been employed in gonorrheal vaginitis, and 
as an ointment in the strength of 5 or 10 per cent, with cosmoline or 
lanolin upon suppurating ulcers and burns. It is without odor, and 
therefore possesses a great advantage over iodoform and similar 
substances which have been used in this manner 



NITRATE OF POTASSIUM. 

Nitre (Potassii Nitras, U. S. and B. P.), or Saltpetre, occurs in 
long, needle-like crystals and has a sharp, saline taste. Sal prunella 
is saltpetre melted and run into moulds. 

Next to the cyanide and chlorate of potassium, this is the most 
poisonous of the potassium salts, and produces when taken in over- 
dose symptoms of violent gastro-enteritis. While it does not affect 
the blood, it is more irritant than the chlorate. 

Nitrate of potassium is rarely employed at present, and has been 
very properly put aside as inferior to the harmless vegetable potas- 
sium salts (the citrate, acetate, and bitartrate). If used in rheuma- 
tism, the dose should be 1 ounce (30.0) in a pint (480 c.c.) of barley- 
water or syrup of acacia and water, to be taken in divided doses 
of a tablespoonful every three hours. Nitrate-of-potassium papers 
(Charta Potassii Nitratis) are made by dipping unsized paper in a 
solution of the drug of the strength of 20 parts of the salt to 80 parts 
of distilled water. They are rolled into cigarettes and smoked by 
asthmatics, or burned in a pan and the fumes arising from them inhaled. 
Their efficacy may be increased in cases where the respiratory mucous 
membrane is irritable by dipping them in compound tincture of ben- 
zoin and exposing to the air long enough to dry. They should then 
be protected from the air until used. The paper used should be 
moderately thin bibulous paper. 



NITRATE OF SILVER. 

Nitrate of Silver (Argenti Nitras, U. S. and B. P.) is a heavy crys- 
talline salt of silver readily soluble in its own weight of water. 



NITRATE OF SILVER. 341 

It is official as the pure nitrate {Ar genii Nitras, U. S. and B. P.) 
and as the sticks or fused rolls {Ar genii Nitras Fusus, U. S.), or lunar 
caustic. The latter are never used in medicine internally, only the 
crystals being employed. Applied to the tissues of the body or other 
substances, nitrate of silver causes a brown and finally a black stain, 
which is due to the formation of an oxide of silver. 

Physiological Action. — Nitrate of silver is one of the few astringent 
substances which are applicable to inflamed mucous membranes, as 
it is, with lead, bismuth, and zinc, one of the few drugs of this class 
which is not irritant as well as astringent. Locally applied, it acts in 
pure form, as a powerful caustic, which is, however, very superficial 
in its effect, as the drug coagulates the albumin with which it comes 
into contact and thereby forms a coat which protects the tissues beneath. 

The action of the drug upon the circulation, respiration, and similar 
vital functions is only partly known, and has no relation to its employ- 
ment in medicine. 

Nitrate of silver is eliminated from the system very slowly. 

Poisoning. — Almost immediately after the ingestion of a poisonous 
dose of nitrate of silver violent pain in the belly, with vomiting and 
purging, is felt. At the same time evidences of widespread gastro- 
enteritis develop. The abdominal walls are knotted and hard, and 
perhaps scaphoid. The face is anxious and livid and covered with 
a sweat. When vomiting occurs the ejecta are brown or blackish, 
or they may be white and curdy. The lips are at first white, 
but quickly become brown, then black. In some cases the nervous 
symptoms are severe, and convulsions with delirium may occur. The 
convulsions are epileptiform. Death ensues either from gastro-enteritis 
or from centric respiratory failure, accompanied by a profuse exudation 
of liquid mucus into the bronchial tubes. 

The treatment consists in the use of common salt, which is the 
chemical antidote, the employment of opium and oils to allay irrita- 
tion, and in the ingestion of large draughts of milk and of soap and 
water for the purpose of diluting the poison and protecting the mucous 
membranes of the oesophagus and stomach from the action of the 
irritant. The bodily heat must be maintained. 

Chronic Poisoning. — This is a form of poisoning quite frequently 
seen. The most prominent symptom is the pale slate-blue color of 
the skin, which causes the individual to be livid and death-like in 
appearance. 

Argyria, as chronic silver poisoning is called, is caused by the con- 
tinued employment of the drug until it is deposited in the tissues. 
It is then found in every part of the body. The first signs of dis- 
coloration can generally be seen in the darkening of the conjunctiva 
over the sclerotic coat of the eye or in a dark line on the inner part 
of the lips. 

The treatment of argyria is not hopeful so far as the color of the 
skin is concerned, but the discoloration may be slightly modified in 



342 DRUGS. 

some cases by the prolonged use of iodide of potassium to aid in the 
elimination of the silver. 

Therapeutics. — Internally this salt is used as a cure for gastric ulcer, 
and it is certainly the best remedy we possess if combined with extract 
of hyoscyamus or opium and given in pill form. In chronic gastric 
catarrh and gastritis nitrate of silver is very useful when the patient 
is troubled with sour eructations or when vomiting occurs after meals. 
When used in these states, it should be given in \ to \ grain (0.01- 
0.015) doses, half to one hour before each meal, in order that the 
stomach may be exposed to its effects and not be protected by food. 

In intestinal ulceration the drug has been highly recommended by 
Pepper, and under these circumstances should be given in hard 
or keratin-coated pills, in order that it may pass through the stomach 
without being chemically changed. In ulceration of the c&cum and 
rectum and in acute and chronic dysentery the disease may be attacked 
by rectal or colonic injections of nitrate of silver. If the caecum is 
involved, the solution must be given in large quantity in order to reach 
the part affected; but if the rectum is diseased, the amount of liquid 
injected should not exceed 4 ounces, the bowel in either case being 
washed out beforehand by warm water to rid it of feces. Soap and 
water and salt and water must not be used for this purpose, as the 
soap or salt which remains in the bowel will prevent the silver salt 
from acting. The strength of the solution employed should be 1 
drachm to 3 pints (4.0-1440 c.c.) of water in csecal trouble, and 3 
grains (0.20) to each 4 ounces (120.0) in rectal trouble. If the latter 
condition is very obstinate and chronic, the strength may be increased 
to 5 grains (0.3) to each 4 ounces (120.0). 

Whenever nitrate-of-silver injections are used in this way, a solu- 
tion of salt and water should be ready for use, and injected if 
the action is too severe or as soon as it is thought that the drug has 
acted with sufficient thoroughness. 

Nitrate of silver was at one time thought to be of value in lateral 
and posterior spinal sclerosis, but rarely does good. 

Nitrate of silver has been largely used in epilepsy and chorea, but 
is now seldom so employed, and does little good in most cases. 

Pepper thought highly of the continual administration of nitrate of 
silver in pill form in the dose of ^ to \ grain (0.01-0.015) through the 
entire course of typhoid fever, and believed that it greatly modified 
the severity of the disease. 

Externally, nitrate of silver is used for many purposes, and will 
often prevent the pitting of smallpox if on the fourth or fifth day the 
vesicles are punctured by a needle dipped in a solution of nitrate of 
silver in the strength of 20 grains (1.3) to the ounce (30.0) of water. 
Others simply paint the skin over the eruption with a solution of 
5 to 10 grains (0.30-0.60) to the ounce (30.0), claiming that this 
method is equally effective and prevents inflammation and suppura- 
tion. 



NITRA TE OF SIL VER. 343 

Higginbottom has highly recommended the use of nitrate of silver 
upon erysipelatous inflammations, but the practice is not often resorted 
to, and is now supplanted by better measures. (See Erysipelas.) In 
other inflammations of a superficial character nitrate of silver is of 
great value. Painted in strong solution over the scrotum in the early 
stages of orchitis or epididymitis, it will often relieve the pain and 
diminish swelling, and felons may sometimes be aborted by its early 
application in concentrated solution over the surface of the finger. 

In all inflammations of the pharynx, larynx, fauces, and mouth 
solutions of silver nitrate may be used in varying strength. Some- 
times after slight exposure to cold or dampness the posterior wall of 
the pharynx suddenly becomes sore and raw, feeling as if the mucous 
membrane had been scarified. A solution of nitrate of silver will 
relieve this condition, and if it is employed in the strength of 60 
grains (4.0) to the ounce (30.0) of water, the application will be more 
efficacious and less painful than if weaker solutions are employed. 

In laryngeal phthisis a spray, from an atomizer, in the strength of J 
to 2 grains (0.03-0.12) to the ounce (30.0) of water may do good service. 

In whooping-cough Ringer recommends the use of a spray in the 
strength given above for the purpose of relieving the cough in vio- 
lence and frequency and of obtaining a good night's rest. The appli- 
cations should be made when the stomach is empty, as they are apt to 
bring on retching. The tip of the atomizer must be within the mouth 
or the skin of the face will be stained. 

In the subacute stages of gonorrhea an injection of nitrate of 
silver of the strength of h grain (0.03) to 3 ounces (£0.0) of water is 
useful. (See Gonorrhoea, Part IV.) 

In uterine ulceration and in leucorrhcea when the cervix is boggy 
and tender, the application of the solid nitrate-of-silver stick is of 
service. Its use is often followed by headache about the vertex, and 
this in turn is to be relieved by 10-grain (0.60) doses of the bromides. 

In pruritus pudendi vel ani and vulva? a solution of 4 to 6 grains 
to the ounce (0.25-0.40:30.0) should be painted with a camel's-hair 
brush over the parts to relieve the itching. The application is to be 
made from two to four times a day. 

Bed-sores may be aborted if, . as soon as the skin reddens, an 
aqueous solution of nitrate of silver of the strength of 20 grains to 
the ounce (1.3-30.0) is applied with a brush to the part. For obvious 
reasons this measure often fails in paralytics. 

Boils which begin in a small limited papule with a surrounding 
area of inflammation may sometimes be aborted by painting a strong 
solution of this salt around them. 

In granular lids, conjunctivitis, and similar affections about the eye 
nitrate of silver in stick form or in solution is largely and successfully 
employed. (See Conjunctivitis.) 

When it is desired to remove nitrate-of-silver stains, they should 
be washed with a solution made of cyanide of potassium 2 \ drachms 



344 DRUGS. 

(10.0), iodine 15 grains (1.0), and water 3 ounces (90.0); or dissolve 15 
grains (1.0) of corrosive sublimate in 7 ounces (210.0) of boiled 
water, add about 45 grains (3.0) of table salt (a scant teaspoonful) 
just before using, lay the stained materials in the mixture for about 
five minutes, and then wash them two or three times in pure water. 

Administration. — The dose of nitrate of silver is ^ to J grain 
(0.01-0.015) in pill form. Mitigated caustic, or diluted nitrate of 
silver (Argenti Nitras Mitigatus, U. S. and B. P.), is composed of 
equal parts of nitrate of silver and potassium nitrate, and is good as 
a mild caustic. 

The drug when given continuously should be discontinued for two 
weeks at the end of the eighth week, as it is so slowly eliminated that 
it accumulates in the body and causes argyria; but Lewin and 
Soullier assert that the smallest aggregate amount on record which 
has produced argyria is 1 ounce. 

NITRIC ACID. 

Nitric Acid (Acidum Nitricum, U. S. and B. P.), the strongest and 
most corrosive of the mineral acids used in medicine, is a clear liquid, 
becoming slightly yellow with age. It should be kept in dark, glass- 
stoppered bottles. 

Physiological Action. — When in pure form, nitric acid acts upon 
the tissues of the body as a powerful caustic. Applied to the mucous 
membranes, well diluted, it acts as an irritant or astringent, and when 
taken internally it exerts a stimulating influence over the secretory 
glands of the stomach and small intestine. It does not tend to relax 
the bowels, as does nitro-hydrochloric acid. Continued for a long 
period of time in small doses, it is said to cause slight salivation and 
looseness of the teeth. Nitric acid coagulates albumin. 

Poisoning. — When nitric acid is taken in concentrated form, it pro- 
duces a widespread gastro-enteritis, intense pain in the mouth, oesoph- 
agus, and abdomen, and finally death from the inflammation induced 
or from collapse. If the patient survives the acute stages, he may 
die from secondary cringes in the stomach and bowels, such as stric- 
ture or destruction of the peptic tubules. The stain made by the acid 
about the mouth and on clothing is deep lemon-yellow. Renal irri- 
tation is often a severe symptom, and the urine and the passages 
from the bowels may be bloody. 

The antidotes are any mild alkali, as magnesia, chalk, or plaster 
from the walls of the room, the use of oils and opium to relieve 
irritation, and the maintenance of bodily heat. 

Therapeutics. — Nitric acid is used externally in medicine'as a caustic 
for chancres and chancroids, the surrounding tissues being protected 
by oils or ointments. 

Nitric acid may also be used on warts, in cases of gangrene to destroy 
the tissues, and on phagedenic ulcers. Whenever the acid is to be applied 



NITRITE OF POTASSIUM. 345 

for such purposes, a solution of soap and water should be at hand to 
neutralize the effects as soon as it has acted deeply enough. Nitric 
acid is also used externally in a dilute form, 5 to 30 minims to the 
ounce (0.30-2.0:30.0), as a stimulant and astringent to indolent ulcers. 

Internally, nitric acid is used as a tonic and astringent. In the 
oxalic-acid diathesis when oxaluria is present, nitric acid will give 
relief when nitromuriatic acid cannot be obtained, although the latter 
is preferable. When small ulcers exist in the mouth or stomatitis is 
present, 3 minims (0.20) of nitric acid at a dose, in water, will often 
be of service, but it should be taken through a tube to protect the teeth. 
In gastric indigestion in which, sometimes after a meal, undigested 
food regurgitates into the mouth, a few drops of nitric acid in water 
after meals will often give relief. In intestinal dyspepsia coming 
on some hours after meals, and in which not only discomfort but pain 
may be felt in the hypochondrium, nitric acid with some bitter tonic 
is most efficient, and it will often cure the green diarrhoea of children, 
particularly that met with in summer, bringing about these changes 
not only by its astringent power, but also by its stimulating effect on 
the intestinal glands. Combined with some good pepsin, it will give 
relief in the chronic diarrhoea of children associated with lientery, and 
in which the stools may be pasty or watery and at the same time ill- 
smelling. 

Ringer recommends the employment of nitric acid in the treatment 
of piles. The strong acid should be used, and simply touched to one 
or two points, not swept over the whole surface. The pain is 
slight, or none at all may be felt. A slough results, and finally comes 
away, leaving a cicatrix which as it contracts diminishes the size 
of the pile. 

The same author also states that a lotion of nitric acid in the 
proportion of \ to 1 drachm to a pint (2.0-4.0:480 c.c.) of water 
is of service in bleeding hemorrhoids, arresting the bleeding, constring- 
ing the parts, and relieving the sensation of weight and fulness so often 
a pressing symptom. 

The dose of dilute nitric acid (Acidum Nitricum Dilutum, U. S. 
and B. P.) is 3 to 15 minims (0.20-1.0), well diluted, and taken through 
a tube to protect the teeth. 

An exceedingly strong preparation, Acidum Nitricum Fumans, is 
official in the B. P. 

NITRITE OF POTASSIUM. 

Nitrite of Potassium is a salt used largely in modern medicine to 
take the place of nitrite of amyl, but it possesses greater stability, 
and is, therefore, more lasting in its effects. It is used for the relief 
of angina pectoris or heart-pang, in the treatment of gastralgia, and 
in epilepsy. The dose is from 3 to 5 grains (0.20-0.3), although 
much larger doses have been employed. These larger doses are, 



346 DRUGS. 

however, not devoid of danger. Nitrite of potassium is eliminated 
by the lungs and by the kidneys as a nitrate. (See Nitroglycerin.) 

Cobalto-nitrite of Potassium. 

This preparation has been employed successfully as a substitute 
for the nitrite of potassium. As it is a more stable compound, it is 
less rapidly broken up in the system, and so exercises a more pro- 
longed influence. For this reason it does not act so vigorously or 
suddenly, which is a great advantage in some cases. Its use is 
identical with that of the rest of the nitrite group. The dose is \ 
grain (0.03) every three hours. 

NITRITE OF SODIUM. 

Sodium nitrite (Sodii Nitris, B. P.) is used for the same purposes 
as nitrite of potassium in the dose of 1 to 2 grains (0.06-0.12) given in 
pill or cachet. 

NITROGLYCERIN. 

Nitroglycerin, sometimes called trinitrin or glonoin, is a compound 
which, in its pure state, is used largely as an explosive, but it is employed 
in medicine in a dilute form as a useful drug in those instances where 
a somewhat rapid and powerful effect is to be exercised over the vas- 
cular system. As its influence lasts but a short time, it should be given 
every three or four hours. Its physiological action is identical with 
that of the nitrites, such as the amyl nitrite (which see), except 
that it is not so violent or fugacious as the latter nor so persistent in 
its effects as the nitrites of sodium and potassium. The dose is 1 to 
2 minims (0.05-0.10) of a 1 per cent, solution in a little water or in 
a pill, and no more than this may be employed at one dose unless the 
patient takes the remedy for a considerable period of time, when as 
much as 60 minims may be administered. Often good results are 
obtained only by giving ascending doses. It is noteworthy that patients 
rapidly become immune to the drug, and Reading has recorded a case 
in which, after a year of treatment, 1 drachm (4.0) of a 10 per cent, 
solution was taken daily with good effect. The author has given as 
much as 1\ grains a day. The drug is largely employed in angina 
pectoris (see Part IV.), and sometimes in epilepsy and chorea and in 
gastralgia. Da Costa and others have highly commended this drug 
in the treatment of chronic parenchymatous nephritis, as it distinctly 
decreases the excretion of albumin from the kidneys. In interstitial 
nephritis, with cardiac disturbance resulting from the renal changes, 
in which there is a marked increase in arterial pressure, so that auscul- 
tation reveals at the second right costal cartilage an accentuated second 
sound due to the forcible closure of the aortic leaflets, nitroglycerin 
often produces a good effect by reducing the pressure and relieving 



NITRO-HYDROCHLOMC ACID. 347 

the heart of strain. This use of the drug is its most important applica- 
tion. (See article on Heart Disease, in Part IV.) It is when attacks 
of angina pectoris seem to be accompanied or preceded by marked 
vascular spasm that nitroglycerin is chiefly indicated. In cases of 
asthma dependent upon spasm and engorgement of the mucous mem- 
branes of the bronchial tubes it is serviceable. Humphreys asserts 
that nitroglycerin is a most valuable drug in vomiting of all kinds, 
except that of pregnancy and peritonitis. Given in the dose of ^ijo" 
grain (0.0003) hypodermically with morphine it prevents the after- 
nausea usually produced by opiates. Nitroglycerin usually causes a 
considerable increase in urinary flow by reason of the relaxation of the 
renal bloodvessels which it produces, particularly in Bowman's capsule. 
Because nitroglycerin relaxes arterial tension and so relieves the heart 
of a certain amount of labor in cases characterized by high arterial 
tension, thereby doing good when the heart is tired because of the 
labor required of it, many physicians have come to employ it as a 
cardiac stimulant in acute diseases without high tension of the blood- 
vessels. There is no justification for this use of the drug, for it is not 
a stimulant. 

The watery solution used in medicine is too weak to be explosive. 
Tablets of nitroglycerin (Tabellce Trinitrini, B. P.) each contain -^-q 
grain (0.0003). The Spiritus Glycerylis Nitratis is an alcoholic solu- 
tion of glyceryl nitrate. It should be kept in tightly-stoppered tins, 
never in glass, and be stored in a cool place, away from heat. Its 
explosiveness is in direct ratio to the evaporation of its alcohol. The 
dose of the spirit is the same as that of the watery solution — namely, 
1 to 2 minims (0.05-0.1). Liquor Trinitrini, B. P., is practically 
identical with the spirit just named, and is given in the same dose. 

Erythrol Tetranitrate. 

Erythrol Tetranitrate is a white crystalline substance, soluble in 
alcohol, but insoluble in water. It is explosive on percussion or 
trituration, and is employed in the place of nitroglycerin for the pur- 
poses just named. It is not so useful, however. Its dose is J to \ 
grain (0.015-0.03), given in solution or in tablets. 

NITRO-HYDROCHLORIC ACID. 

Nitro-hydrochloric Acid (Acidum Nitro-hydrochloricum, U. S.) is 
a liquid giving off a distinct odor, possessing caustic power, and 
staining the tissues of the body a light yellow. It is official in the 
form of the dilute acid (Acidum Nitro-hydrochloricum Dilutum, U. S. 
and B. P.), in which form it is useless except as an ordinary acid. 
When it is wished to use the acid for its own peculiar effects, the 
official dilute acid ought always to be supplanted by the freshly-mixed 
strong acid, which should be of an orange color. If this cannot be 



348 DRUGS. 

obtained, the physician should prepare the compound himself by 
adding 4 parts of medicinally pure nitric acid to 16 parts of hydro- 
chloric acid, and allowing the mixture to stand in an open bottle until 
fumes are no longer given off in excess, when it should be tightly 
corked and kept in a dark place. This acid ought to be freshly 
prepared every few days. 

Poisoning. — The symptoms caused by poisonous doses are those of 
violent gastro-enteritis with vomiting and purging of bloody materials. 
Death may occur from perforation of the alimentary canal, from inflam- 
mation of the abdominal viscera, and from destruction of the peptic 
tubules or constrictions of the oesophagus or bowel. The treatment 
consists in the use of alkalies, such as magnesia, lime, plaster, soap, 
and oils, with opium to allay irritation. The use of external heat to 
prevent collapse is also to be resorted to. 

Therapeutics. — Nitro-hydrochloric acid is an invaluable remedy in 
many cases of indigestion arising either in the stomach or bowels, 
as it acts as a tonic and stimulant to secretion. Upon the biliary 
flow its action is marked, and it may even cause bilious purging if 
administered in full doses for some days. It is therefore largely used 
in hepatic torpor, either acute or chronic, and in the early stages of 
hepatic cirrhosis should always be resorted to. In the chronic hepatitis 
of hot climates it is exceedingly useful, but it is not to be employed in 
acute sthenic hepatitis, as it is a stimulant to the liver, which, under 
these conditions, needs quieting. When used in chronic hepatitis it 
should be given in full dose and pushed to its physiological limit, 
as evidenced by the bilious purging produced or by signs of gastro- 
intestinal irritation. 

A useful additional means for obtaining the beneficial effects of 
this acid is to use it by means of the foot-bath or general bath. As 
used by Johnson in India, the acid for this bath is prepared by slowly 
and carefully adding together 2 parts of nitric acid and 3 parts of hydro- 
chloric acid, and after twenty minutes mixing carefully with these dis- 
tilled water 5 parts. For the general bath (in a wooden tub) take 5 
pailfuls of water, 64 fluidounces (2 litres + ) of the acid mixture, and 
enough boiling water to raise the temperature to 98° F. Keep the patient 
in the bath twenty minutes. Then rub him thoroughly with warm 
towels and place him in a dry, warm bed. For the foot-bath add 6 
ounces (180.0) of the acid to 2 gallons (7 litres) of water at 98° F., and 
bathe the thighs and calves of the legs for twenty minutes with a sponge 
wet with the mixture. This is a very useful treatment, according to 
Stille, for cases of alcoholic hepatic torpor. If in either case the skin 
becomes irritated, less acid is to be used. 

In ordinary so-called biliousness, which is not biliousness, but intes- 
tinal indigestion, this acid is often of great service. (See Indigestion 
and Biliousness.) It is also of value in lienteric diarrhoea where the 
dysentery results from defective secretory action on the part of the 
glands which pour out the proper fluids for digestion. 



NITROUS OXIDE. 349 

Another very important action of nitro-hydrochloric acid is the 
remedial influence it exerts in cases suffering from oxaluria, par- 
ticularly if this be associated with melancholia or great mental 
depression. 

Administration. — The strong, freshly-mixed acid should be given 
to the adult in the dose of 3 to 5 minims (0.20-0.3) three times a day, 
well diluted, and taken through a tube, after meals. If the patient is 
intelligent, he should be ordered J ounce (16.0) of the pure acid and 
told how to drop it. If he is not, the physician must order it partly 
or entirely diluted in the prescription, and in so small an amount 
that it will be renewed before it loses any of its power. Warning 
should be given of its effects on clothing with which it may come 
in contact, and care should be taken that the bottle is held some dis- 
tance from the face when the cork is withdrawn, as the acid, if freshly 
mixed, may spurt and burn the eyes and skin. 

NITROUS OXIDE. 

Nitrous Oxide, or Nitrogen Monoxide, is sometimes called protoxide 
of nitrogen, or " laughing gas." Its power to relieve pain was first 
recognized by Sir Humphrey Davy more than one hundred years 
ago. As with ether, so with nitrous oxide, its first use as a surgical 
anaesthetic was by an American, Horace Wells, a dentist. 

This gas is obtained by a complicated process which requires the 
use of such cumbersome apparatus that its manufacture is out of the 
question for the ordinary practitioner of medicine, while the fact that 
several firms prepare the gas and market it in cylinders ready for 
use renders its preparation on a small scale unnecessary. The gas is 
devoid of odor, but possesses a slightly sweet taste. It may be kept 
in gaseous form, or liquefied and allowed to become gaseous as it 
is used. 

Physiological Action. — Owing to the symptoms sometimes produced 
in patients inhaling this gas, it has received the popular name of 
" laughing gas/' but a condition of hilarity is rarely seen when the 
inhalations are full and deep, and only comes on in the majority of 
cases where the gas is given in small amounts or inhaled very slowly. 
When used properly, the patient is directed to take long, deep inspira- 
tions from the tube placed in the mouth, the nose being held so that the 
nostrils are closed. Under these circumstances the face becomes for 
a moment flushed, then of a deadly pallor, and finally the jaw drops 
if the effect is complete. At this time anaesthesia is complete and the 
operation is to be rapidly performed. Owing to the fact that when pure 
it is devoid of irritant properties, this gas can be used when ether and 
chloroform are contraindicated. 

According to some careful studies upon the action of this gas (Kemp), 
it has no direct effect on the heart and vasomotor system , but indirectly 
it causes a rise of arterial pressure by the slight asphyxia which is pro- 



350 DRUGS 

duced. The anaesthesia may be due in part to the non-oxygenation 
of the blood during the time the gas is in this fluid, but the gas pro- 
duces anaesthesia aside from any such influence by a direct action on 
the cerebral cortex. It is a curious fact that the conjunctival reflex is 
often preserved after general anaesthesia is present. It has been thought 
that the use of this drug produces temporary glycosuria, but recent 
studies render this doubtful, to say the least. Where permanent gly- 
cosuria has been produced, some injury to the vascular system in the 
region of the diabetic centre in the floor of the fourth ventricle has in 
all probability occurred. Nitrous oxide gas when inhaled rarely pro- 
duces any disagreeable after-effects, save a little light-headed sensation 
or dizziness for a few hours. 

Therapeutics. — Nitrous oxide is a useful anaesthetic in all minor 
operations, such as opening an abscess, boil, or felon, or even ampu- 
tating a digit. It is used by many surgeons at the present time 
for the purpose of beginning an anaesthesia which is to be continued 
by ether or chloroform. The gas possesses two disadvantages, the 
first of which is its brevity of action ; the other, the difficulty in carry- 
ing it from place to place. It possesses a great advantage in almost 
absolute safety, very few deaths having been caused by it directly. 
It is the safest of all anaesthetics, not even excepting cocaine, which 
latter drug has largely supplanted the gas for many minor surgical 
operations. When teeth are to be extracted, a plug or cork is placed 
between the jaws before the gas is given, to keep them apart. The 
cork should always be attached to a string, so that if it slips into 
the back part of the mouth it can be withdrawn before it chokes the 
patient. 

Oxygen gas may be combined with nitrous oxide gas with as great 
advantage as with the vapor of ether or chloroform, although its use 
may delay to a slight extent the development of anaesthesia. The fol- 
lowing classes of persons, according to Hewitt, do better with the mix- 
ture of oxygen and nitrous oxide than with the nitrous oxide alone: 
1. Children (who with nitrous oxide alone are liable to inconvenient 
jactitation). 2. Anaemic and debilitated patients, who, like children, 
quickly exhibit muscular contractions, and, in addition to this, remain 
but a very short time under the influence of nitrous oxide alone. 3. 
Any one who has previously exhibited great susceptibility to nitrous 
oxide per se (such patients are difficult subjects to manage in dental 
practice because of the short period of available anaesthesia). 4. 
Patients who, under nitrous oxide alone, have experienced highly 
unpleasant sensations. 5. Patients very advanced in years. 6. Patients 
with very large tonsils. 7. Patients suffering from heart or lung affec- 
tions. 

Contraindications. — The gas ought not to be given to those who are 
advanced in years or have atheromatous bloodvessels, since the rise 
of arterial pressure consequent upon the asphyxia may rupture a cere- 
bral bloodvessel and thereby cause an apoplexy. 



NUTMEG. 351 

NOSOPHEN. 

Nosophen is a substance obtained by the action of iodine on solutions 
of phenolphthalein, and is a light impalpable powder, without taste or 
odor, and of a yellowish-gray color. It is said to contain 61.7 per cent, 
of iodine. Nosophen is insoluble in nearly all solvents, but is soluble 
in alkaline solutions, and with alkalies it forms salts. The uses of this 
substance are practically identical with those of iodoform in that it 
exercises a favorable effect on tissues by reason of its content of iodine 
and drying properties. Its bulk is four times greater than an equal 
weight of iodoform. When used as an , antiseptic on sores it should 
be brought directly in contact with the living tissue, and not simply 
applied to the pus or scab covering the part. As it will withstand 
a high heat, it can be sterilized by exposure up to 220° F. without 
decomposition. Its lack of odor is a great advantage. 

NUCLEIN. 

Nuclein has been used with asserted success in the treatment of the 
ordinary forms of pulmonary tuberculosis and for septicemia. Theo- 
retically it should prove useful in combating any infectious process, 
but practically nuclein has proved of little value and is not generally 
employed. 

Administration. — The proper way to use the nuclein solution is to 
give 10 to 60 minims (0.60-4.0) hypodermically once, twice, or thrice a 
day under careful antiseptic precautions; or to give a tea spoonful (4.0) 
in a wineglassful of water on an empty stomach thrice during the day 
and at bedtime. Capsules which contain 2 grains (0.12) of nucleinic 
acid may also be used. 

Contraindications. — The nucleins should not be given for a long 
period of time to gouty persons; these patients usually have uric-acid 
troubles under their use, as nuclein is an antecedent of uric acid. 

NUTMEG. 

Myristica, U. S. and B. P., or Nutmeg, is the kernel of the seed 
of Myristica fragrans, an East and West Indian plant, mace being 
the outside covering of the same. Nutmeg is a soporific and nervous 
sedative, exercising a peculiar influence over the cerebrum. It is also 
used as a flavoring substance in somnifacient mixtures, and is of value 
in prescriptions for serous diarrhea. The oil {Oleum Myristiccs, U. S. 
and B. P.) is given in the dose of 1 to 3 minims (0.05-0.20). The 
spirit or essence (Spiritus Myristica?) is used in the dose of 1 to 2 
fluidrachms (4.0-8.0). 

Several instances of poisoning by nutmeg are reported; a severe 
case by Dr. Reading, of Woodbury, N. J. The symptoms closely 
resemble those produced by excessive doses of cannabis indica. 



352 



DRUGS. 



NUX VOMICA 



Fig. 51. 



Nux Vomica (U. S. and B. P.) is the seeds or beans of Strychnos 
nux-vomica, an East Indian tree. It contains two alkaloids, strych- 
nine and brucine, and depends largely for its medicinal power on the 
former. For this reason the statements made in regard to the physiolog- 
ical action of strychnine may practically 
be considered as applicable to the entire 
drug. 

Physiological Action. — When strychnine 
is given to man or the lower animals 
in full medicinal dose it increases reflex 
activity, respiratory rate, pulse-force, 
arterial pressure, the acuity of smell, 
vision, and hearing, and causes general 
systemic irritation or excitement. 

Nervous System. — On the nervous 
system strychnine exerts its chief influ- 
ence. It excites the spinal cord in its 
motor tracts, and probably increases the 
receptive activity of the sensory centres. 
It also has some slight influence in 
increasing the conductive power of the 
motor and sensory nerves. 

In overdose strychnine produces spinal 
or tetanic convulsions by an action exerted 
on the spinal cord. When enormous 
doses are given intravenously, total par- 
alysis, resembling that caused by curare, 
precedes the convulsions, and if artificial 
respiration is not used the animal dies 
from failure of respiration. If death 

A nux vomica stimulates .the motor ta fc es p l ace f rQm fae effects of the drug, 

tracts in the spinal cord and to a slight .-. L , P i , i i 

extent the nerve-trunks; b, in large, the motor nerves are found to be de- 
poisonous doses it depresses the motor pressed, partly as the result of the poison- 

nerve-plate in the muscle and exhausts QUS ^ f ^ strychnine, and partly 

the nerve-trunks. J ' . r J 

as the result of the exhaustion of the 
nerve-trunks by the convulsing impulses which they have carried 
(Fig. 51). 

Circulation. — Nux vomica increases the force of the pulse-beat 
and the pulse-rate by a stimulation of the heart-muscle and its ganglia, 
while the rise of arterial pressure which it causes is due to stimulation 
of the vasomotor centre. If very poisonous doses are injected intra- 
venously, a fall of arterial pressure occurs instead of a rise, which is 
due to vasomotor depression and paralysis. 




NUX VOMICA. 353 

Respiration. — Strychnine is one of the most constant and powerful 
stimulants of the respiratory centre that we have, and it not only 
increases the rate, but also the respiratory capacity. 

Temperature. — Ordinary doses have no effect upon temperature, 
but poisonous doses may raise it by reason of the convulsions. 

Elimination. — Strychnine is eliminated from the body by the kid- 
neys as strychnine and strychnic acid. Most of it is oxidized and 
destroyed by the liver. 

Therapeutics. — Nux vomica, or its chief alkaloid strychnine, is used 
for several purposes in medicine. Owing to its bitter character, it 
may be employed as a simple bitter tonic or as one especially influencing 
the nervous system. It may also be used as a respiratory, cardiac, 
and ocular stimulant. 

In cases of junctional nervous atony, or depression, strychnine does 
good; but in organic disease of the nervous system, if used during 
the period of acute inflammation, as soon after an apoplexy or in acute 
infantile palsy, it is distinctly harmful. Some persons who have suf- 
fered from apoplexy can never take the drug without a spasm com- 
ing on in the paralyzed part or parts, probably through irritation of 
the probably degenerated pyramidal tracts. In acute or subacute 
neuritis strychnine ought never to be used, as the nerves are already 
inflamed, and are not to be still further irritated by the employment of 
nerve excitants. In progressive lead palsy large doses of strychnine 
should be constantly used to check the progress of the disease, iodide 
of potassium also being employed to cause elimination of the lead. 

In amaurosis dependent upon the excessive use of tobacco or alcohol 
strychnine is almost a specific, and in eye-strain resulting from insuffi- 
ciency of the ocular muscles it does great good, curing the insufficiency 
and improving the general condition of the muscles. According to 
de Schweinitz, the patient should use ascending doses of the tincture 
of nux vomica, beginning with 3 minims (0.20) three times a day, and 
increase the amount 2 minims (0.1) a day until distinct physiological 
effects are produced. Sometimes 60 minims (4.0) may be taken in 
twenty-four hours. Recent experiments by the author indicate that 
constantly increasing doses, instead of decreasing the person's sus- 
ceptibility to the drug, actually increase it, so that a moderate dose 
produces greater effects after some days of use than a full dose does 
at first. 

In pneumonia and all other acute diseases in which sudden collapse 
is liable to occur strychnine is of the greatest service at the time of 
need. Often it will pull the patient out of a sinking attack which 
seems certain to end in death. It should be used freely by the hypo- 
dermic needle, and is often aided in producing its good effects by the 
addition of yl-g- to - T -J- - grain (0.0004-0.0006) of atropine to each injec- 
tion. (See Pneumonia and Shock.) 

The author desires to protest most emphatically against the common 
practice of the day, which consists in the use of strychnine as a circur 

23 



354 DRUGS. 

latory stimulant through prolonged exhausting illness. It is essentially 
a whip to the flagging heart, to be used at a crisis, but not continued 
for days. Cases are constantly seen in which the persistent use of 
the drug in fever produces a rapid running pulse and great nervous 
irritation and prolongation of the febrile movement. 

There is no drug known which is so antidotal to the effects of over- 
doses of chloroform as is strychnine. In cases of sudden accidents, with 
arrest of the heart or respiration during the use of this anaesthetic the 
physician should give a hypodermic injection of y^- grain (0.006) of 
strychnine as a powerful, rapidly acting cardiac and respiratory stimu- 
lant, which dose may be repeated in ten minutes if no effect is produced. 

Strychnine is a valuable remedy in surgical shock, and is a better 
antidote to opium than is belladonna. 

In dyspnoea from any cause, such as that of old persons suffering 
from winter cough or bronchorrhoea, in emphysema, phthisis, and in 
shortness of breath, strychnine is of service, and it is a valuable drug 
for the treatment of opium poisoning, because it preserves the reflexes 
and stimulates the respiratory centre. 

In atony of the bowels strychnine is of service, and it is to be added 
to purgative pills to avoid their depressing after-effect on the intestines. 

In cases of hemiplegia, strychnine may be used to keep up the nutri- 
tion of the limbs, which are paralyzed ; but if the paralysis be due to 
disease of the trophic cells in the spinal cord, it does little good except 
to stimulate the remaining cells to greater effort. 

According to Ringer, sick headaches, due to errors in diet and without 
much nausea, can be relieved for the day by the use of 1 minim (0.05) 
of the tincture of nux vomica in a teaspoonful (4.0) of water every five 
or ten minutes until 10 minims (0.60) are taken. 

Strychnine possesses no curative properties in chronic alcoholism. 
Owing to its powerful stimulant properties it may temporarily brace 
the nervous system, but its prolonged use is dangerous. It should be 
employed temporarily only to combat great depression of the system. 

Untoward Effects. — Care should be exercised in giving strychnine 
to children, as they are more susceptible to the drug than are adults. 
The proper beginning dose of strychnine by the mouth for a child of 
five or six years is not more than yj-j- grain (0.0006). In some cases 
of exhausting disease the prolonged use of full doses of strychnine may 
produce a talkative delirium with great peevishness, and, if the drug is 
continued, this condition may pass into a state of temporary insanity. 
Brunton asserts that nux vomica may induce malarial chills in those 
predisposed to them. He also asserts that strychnine acts more power- 
fully when given by the rectum than by the mouth. This is doubtful. 

Administration. — The extract of nux vomica (Extr actum Nucis 
Vomica?, U. S. and B. P.) is given in the dose of -J- to J grain (0.01- 
0.015); the fluid extract (Fluidextractum Nucis Vomica?, J]. S.); Ex~ 
tractum Nucis Vomica? Liquidum, B. P.), in the dose of 1 to 5 minims 
(0.05-0.3) ; the tincture (Tinctura Nucis Vomica?, U. S. and B. P.), in 



NUX VOMICA. 355 

the dose of 5 to 40 minims (0.3-2.6). Strychnines Sulphas (U. S.), 
Strichninoe Nitras (U. S.), and Strychnine? Hydorchloridum B. P.) are 
given hypodermically in the dose of -^ to 2V grain (0.002-0.003), and 
by the mouth in the same amounts. In cases of severe surgical shock 
as much as J grain (0.015) may be used hypodermically. The B. P. 
recognizes a solution (Liquor Strychnine Hydrochloride ; dose, 2 to 8 
minims (0.1-0.5). 

Poisoning. — When a poisonous dose of strychnine is taken, it acts 
either suddenly or gradually. If suddenly, the man or animal may, 
without premonition, be thrown several feet and become rigid by 
contraction of his muscles. If the onset is gradual, some stiffness at 
the back of the neck and uneasy startings may precede the general 
nerve-storm. 

The convulsions are tetanic, or, in other words, tonic, and the 
body is thrown into opisthotonos: that is, resting on the head and 
heels at each convulsion. Rarely the trunk is twisted sidewise or the 
flexion of the body is forward (emprosthotonos). The eyes are open 
and fixed, the corners of the mouth drawn back into risus sardonicus, 
and respiration during a severe convulsion is impossible owing to the 
respiratory muscles being in a state of tetanic rigidity. 

The slightest noise, draught of air, or touch may cause a convulsion 
or convulsion after convulsion, because the sensory impulse, reaching 
the spinal cord, causes a spasmodic motor impulse to be sent out to 
the muscles. 

The convulsions are not absolutely continuous, but periods of utter 
or partial relaxation occur, during which the patient breathes easily. 
The cramp-like contractions of the muscles are exceedingly painful, 
and the patient either dies of cramp asphyxia — that is, through failure 
of respiration because his chest muscles are locked in spasm — or, much 
more rarely, from exhaustion. After death the posture of the body 
may or may not be typical of the strychnine spasm. Usually it is not 
typical, although the severe muscular exertion of the attack may result 
in the early development of marked rigor mortis. Reichert has shown 
that it requires five hundred times the ordinary fatal dose of strychnine 
to cause death in animals if artificial respiration is properly main- 
tained. The average fatal dose for an adult is 1J to If grains (0.10- 
0.12). Death has occurred from \ grain (0.03) and recovery after 
swallowing 19 grains (1.25). 

Treatment of Poisoning. — The attendant should give at once, if no 
symptoms have appeared, inhalations of nitrite of amyl, and mean- 
while employ the stomach-pump, using the nitrite to prevent any con- 
vulsive tendencies during the operation. Draughts of water containing 
tannic acid, as the chemical antidote, are to be administered, and 
after the stomach is washed out 60 grains (4.0) of bromide of potas- 
sium and 20 grains (1.3) of chloral in solution are to be given. These 
are the physiological antidotes, for the bromide of potassium depresses 
the sensory tracts of the spinal cord, and the chloral depresses the 



356 DRUGS. 

motor tracts. If the convulsions prevent swallowing, the patient must 
be chloroformed with care, and the physiological antidotes given in 
starch-water by the rectum, muscular relaxation being maintained by 
the anaesthetic until the drugs are absorbed. Ether cannot be used 
as a relaxant, as it is too irritant and too slow. Nitrite of amyl is 
a physiological antidote, but it is useless if a complete convulsive 
attack is present, as it cannot be inhaled if the chest is immovable. 
Neither can any other relaxant, such as chloroform, be used under 
these circumstances. These drugs should be gently given between the 
paroxysms. If relaxation does not occur, the nitrite of amyl should 
be injected hypodermically. 

While a light touch may produce a spasm, it is said that a firm, 
hard grasp of the limb often relieves the pain of the cramp. Sensation 
and consciousness are preserved in strychnine poisoning unless the 
asphyxia obtunds them. 

Differential Diagnosis. — The convulsions of strychnine poisoning 
do not resemble those of epilepsy, because they are distinctly tonic and 
never clonic. From tetanus, strychnine poisoning is to be differentiated 
by the fact that in tetanus the locking of the jaws comes first, while 
in strychnine poisoning it comes last. The convulsions of tetanus 
rarely, if ever, completely relax, while those of strychnine do have 
periods of relaxation. There is a different history in each case — in 
one perhaps of an injury, as of a nail run into the foot; in the other, 
of a dose of poison having been swallowed. 

The differential diagnosis of strychnine poisoning from hysterical 
convulsions is more difficult. The convulsions are rarely so persist- 
ently tonic in hysteria, and the peculiar expression of the hysterical 
face is often seen in such cases. The history of the patient, if obtain- 
able, will throw much light on the case and aid very materially in the 
differentiation of the two conditions, while the peculiar variations in 
cutaneous sensibility, such as areas of hyperesthesia and anaesthesia, 
which are so characteristic of hysteria, may render the diagnosis 
possible. 

As the treatment of all these states is virtually identical, the employ- 
ment of the measures just suggested may be resorted to in each instance, 
and the diagnosis made afterward. 

OPIUM. 

Opium (U. S. and B. P.) is the juice or milky exudation appear- 
ing on the surface of the unripe capsules of white poppy, or Papaver 
somniferum, a native plant of Asia, now grown in many other parts of 
the world. 

Good opium, according to the U. S. P., should contain at least 9 per 
cent, of crystalline morphine, but the powdered opium (Pulvis Opii, 
U. S.) should contain not less than 12 nor more than 12} per cent, of 
morphine, 



OPIUM. 357 

The chemical composition of this drug is very complex, no less than 
seventeen alkaloids having been obtained from it, the most important 
of which are morphine, codeine, narcotine, thebaine, narceine, papaver- 
ine, pseudomorphine, and laudanine. It also contains meconic acid 
and meconine. 

Physiological Action. — The action of opium upon man and the lower 
animals varies with the degree of intelligence or cerebral development. 
It quiets the brain and excites the spinal cord. 

Nervous System. — The dominant action of opium upon man is to 
produce nervous sedation in small doses and sleep when given in larger 
amounts. Sometimes, however, in persons who are accustomed to its 
use, it produces a state of restless insomnia or quiet, wakeful apathy. 
When given to frogs, it often produces tetanic convulsions, owing to its 
primary stimulant effect on the spinal cord. In dogs it increases the 
reflexes and produces drowsiness, and in man sleep. If, however, the 
patient be a member of one of the lower races or a young child, the 
spinal irritation may be as manifest as the cerebral sedation. If large 
doses are given, sleep is produced in all animals, and both the brain 
and spinal cord are depressed. The sensory nerves are also markedly 
benumbed, and the motor nerves may finally be rendered inactive. 

Circulation. — Small therapeutic doses of opium have no effect 
upon the circulation, but large ones slow the pulse, increase its force, 
and slightly raise arterial pressure. 

The slowing of the pulse depends upon stimulation of the pneumo- 
gastric nerves peripherally and centrically; the increase in pulse-force 
results from the stimulation of the heart-muscle and its ganglia; the 
rise of pressure is due chiefly to the increased heart-action. 

After poisonous doses the pulse becomes rapid and feeble, due to 
depression of the vasomotor centre and the heart, and the gradually 
increasing asphyxia. 

Respiration. — In very minute doses opium is a feeble stimulant, 
or at least not a depressant, to the function of respiration. In over- 
dose it is one of the most powerful paralyzants of the respiratory centres 
in the medulla oblongata, causing death by this action. 

Temperature. — The bodily temperature is raised slightly by full 
doses and lowered by poisonous amounts of opium. 

Tissue-waste. — Opium acts as a preventive to tissue-waste, decreas- 
ing the elimination of urea and other results of nitrogenous breakdown. 

Elimination. — If given in excess, the drug escapes from the body 
as morphine, by way of the intestine and kidneys, but most of it is 
destroyed by oxidation in the liver and tissues. Experiments made 
by Alt and Tauber show that morphine is largely eliminated by the 
stomach, and that if this viscus is frequently washed out during a case 
of poisoning, recovery is much aided, as by this means resorption is 
prevented. 

Pupil. — Opium contracts the pupils by a centric stimulation of the 
oculomotor nerves, and perhaps by depression of the sympathetic fibres. 



358 DRUGS. 

Stomach, Intestines, and Secretion. — Opium depresses the 
motor activity of the stomach and intestines and produces constipa- 
tion. It does this by stimulating the splanchnic inhibitory fibres of 
the intestine and thereby preventing peristalsis. In very large doses 
it increases peristalsis by paralyzing these fibres. 

Opium checks every secretion in the body except that of the skin. 
Acute Poisoning. — When opium is taken by man in overdose, it 
causes drowsiness, deep sleep, full breathing, a slow, full pulse, a 
warm, dry skin, contracted pupils, and pleasant — or, more commonly, 
in the Anglo-Saxon race, disagreeable — dreams or no dreams at all. 
Preceding this period there may be a brief one during which the 
individual feels self-satisfied and contented. The duration of this agree- 
able sensation lasts only a short time, and if the dose is large does 
not occur or is evanescent. It has been called the first stage, while 

the more marked symptoms first 
FlG - 52 - described have been grouped into a 

so-called second stage. 

During the sleep of the second 
stage the patient may be roused by 
shouting in his ear or by violent 
shaking, but sinks into slumber at 
once when not disturbed. 

Many of the symptoms resemble 
those of congestion of the brain. 
a, opium produces sleep by depressing The face is suffused and reddened, 

the intellectual centres of the brain, and 1 _ 1 n ll J* j.' xi 

B, relieves pain by depressing the perceptive an /* m W be fina % distinctly Cyan- 

centres in the brain. otic. The breathing may be puffing 

and stertorous. When the patient is 
awakened, he breathes more rapidly, and for this reason the duski- 
ness of the face disappears and the normal hue returns. Death never 
occurs in the second stage of opium poisoning from the poison alone, 
but if a complicating disease is present death may take place at this 
time. 

The third or fatal stage emerges from the second by a process so 
gradual that no abrupt line of separation can.be noted. The face 
becomes at first more cyanotic, then pale and livid; the respirations, 
which have been 8 . to 10 to the minufe, are now only 4 or 5, and 
finally such prolonged pauses occur that all hope of another respi- 
ration is lost by the attendant. While the slow breathing is at first 
deep, it soon becomes shallow, and muscular relaxation is present 
to the greatest degree. The skin, previously dry, is wet with the 
sweat of death, the patient is so deeply narcotized that nothing can 
arouse him, and he dies from respiratory failure, although the heart 
may cease almost simultaneously from the asphyxia. The pupils do 
not dilate in the third stage, except in the relaxation of death. 

Treatment of Acute Poisoning. — After employing the usual 
methods resorted to for the purpose of emptying the stomach, and 




OPIUM. 359 

after giving permanganate of potassium or tannic acid, .preferably the 
former, as the chemical antidote, the patient should receive by the 
rectum one or more cups of black coffee, hot and concentrated. The 
heat in the liquid is useful in maintaining bodily temperature, and the 
caffeine stimulates the respiratory centre and keeps the patient awake. 
Coffee should be used even before any symptoms come on, in order to 
prevent their onset if possible. If strychnine is at hand and the respi- 
rations are becoming very slow, -g^ to -^ grain (0.002-0.006) should be 
given hypodermically. Strychnine is much better than atropine as an 
antidote to opium, and should be given hypodermically in full dose, 
repeated frequently enough to keep the nervous system of the patient 
active and respiration intact. The pupil is no guide as to the action of 
atropine in opium poisoning, as the influence of these two drugs (opium 
and atropine) on the eye is not directly antagonistic. Cocaine is 
thought by some physicians to be a satisfactory physiological anti- 
dote to opium. 

Alcoholic stimulants may be called for, and ammonia as a cardiac 
and respiratory stimulant may be resorted to. 

In the third stage heat should be applied to the trunk and extrem- 
ities. 

Much emphasis has been placed on keeping the patient awake, 
and it has been thought that the cause of death was the deep sleep. 
This is not so. The man must be kept awake in order that he will 
supplement the efforts of his depressed respiratory centres by volun- 
tary breathing. If he sleeps, he forgets to breathe, and sleep means 
death for this reason, and not because sleep in itself produces death. 

Besides the use of hot strong coffee, the patient may be kept 
awake by lashing him with switches or by walking him up and 
down between two attendants. Both of these measures are reprehen- 
sible if anything better can be done — the first method because it 
covers the patient with cuts and bruises, the second because it may 
aid in the production of death by exhaustion. If an ordinary medical 
faradic battery is at hand, the full force of the current may be allowed 
to come in contact with the skin from two small poles wet with salt 
water, or, better still, the dry or wire electric brush should be swept 
over the body while the negative pole is held in the hand of the patient 
or pressed against his skin. This causes the most exquisite pain in 
the normal individual, but if the brush is kept moving will not cause 
bruises or discoloration. (See Asphyxia.) Artificial respiration may 
be resorted to. 

As pointed out when discussing the elimination of opium, the 
drug is eliminated into the stomach from the bloodvessels and then 
reabsorbed. Frequent washing out of the stomach is therefore advis- 
able in cases of poisoning. 

Chronic Poisoning. — Morphine or opium when taken constantly 
generates a habit. The person — or morphine-habitue, as he is some- 
times called — depends for a comfortable existence on the drug, and 



360 DRUGS. 

day by day increases the dose until the mc :t extraordinary amounts 
are taken by the stomach or by means of the hypodermic needle. If 
the drug is withheld, a train of symptoms typ^ving depression or 
exhaustion ensues. The pulse is scarcely to be feit, horrible mental 
depression and melancholia come on, the miserable man or woman 
wrings his or her hands, and begs, screams, howls, or yells for mor- 
phine, only to break down and cry on being refused the customary 
dose. Diarrhoea of a serous type and most violent in character, with 
cramps in the muscles, may assert itself, and must be controlled by 
astringents and an active line of treatment as far as possible free 
from opium. (See Diarrhoea.) 

A characteristic symptom of chronic opium-eating is the develop- 
ment of the most clever lying in previously truthful persons. In the 
same breath that the patient begs the physician to cure him, he will 
lie to obtain the drug in a surreptitious manner, and may even have 
the drug in his mouth at the moment he speaks. It will often be 
found hidden in the seams of the clothing, and the nurse must be 
absolutely reliable, above bribery, and forever on the watch lest the 
drug be obtained by smuggling. Any sudden improvement on the 
part of the patient should be placed to the credit of more morphine, 
not to professional skill. 

The well-known fact that certain races of mankind are affected 
by some drugs in quite a different manner from that exerted upon 
the white race finds an interesting confirmation in the opinion 
expressed by physicians and government officials who have investi- 
gated the subject in India and China, that a large number of Orientals 
use opium in moderation for years without deleterious effects. They 
remain well nourished, are able to perform labor requiring severe 
physical exertion, and the death rate among them is not higher than 
among other classes of people. 

Sometimes paregoric is taken in excess, and the writer has seen and 
treated a case in which over a pint of paregoric was taken every day. 

When a mother is an opium-eater, the new-born child often suffers 
from collapse on the second or third day after birth, owing to the lack 
of its customary dose of opium. 

Treatment. — The best way to decrease the use of the drug is to 
" taper off " the daily dose, and to decrease by a sixth or a fourth 
the total customary amount in each twenty-four hours. The sudden 
complete withdrawal of the drug is an unnecessarily severe measure, 
and its withdrawal in a slower manner than that named is simply 
prolonging the treatment beyond reasonable limits. 

A very valuable means of treatment is the use of massive doses of 
hyoscine hypodermically. If this plan is followed, the morphine may 
be withdrawn at once. (See Hyoscine.) If the circulation flags, 
digitalis and strychnine may be given and the remaining symptoms 
treated as common sense indicates. Cocaine has been used to tide 
over the crisis after the withdrawal of the morphine, but too fre- 



OPIUM. 361 

quently the patient passes from opium to the cocaine, and finally to 
the alcohol habit, all of which are equally bad. 

Therapeutics. — Opium is used for the relief of five great conditions, 
which will be spoken of seriatim, the minor uses of the drug being 
considered afterward. These are pain, insomnia, inflammation and 
irritation, oversecretion, and systemic strain. 

Pain. — Opium is the best remedy that we possess for the relief of 
all forms of pain, except in those instances when neuralgia is present, 
when antipyrin and its fellow-compounds exceed it in medicinal value 
because they have no marked after-effects. It is to be remembered, 
however, that no drug has yet been discovered which equals its pain- 
relieving power in this or any other painful affection. In one form of 
pain opium is not to be employed — namely, that arising from cerebral 
congestion and cerebritis, for it is distinctly contraindicated in these 
affections, as it aggravates them. In acute or traumatic meningitis, 
however, opium is of great service, either alone or combined with 
mercury in sthenic cases. In the treatment of renal and hepatic 
colic associated with spasm, and in dysmenorrhea, belladonna 
and opium given together will relieve the spasm and pain, and 
yet so counteract each other elsewhere in the body as to be devoid of 
marked effect upon other organs. Usually in these severely painful 
affections it is best to give morphine and atropine hypodermically. 
Persons suffering from severe pain will always bear larger amounts of 
opium than individuals without pain. 

For the relief of violent pain physicians of experience usually employ 
morphine hypodermically as the most rapid and effective means of 
giving relief. If this is not possible, the morphine should be given 
by the mouth in a little hot water with or without whiskey or brandy 
added to it; or deodorized tincture of opium may be given in the same 
manner. If neither the hypodermic needle nor the draught can be 
resorted to, then the drug is best given in the form of the fluid extract, 
or tincture, by the rectum, being first mixed with warm starch- 
water. If the pain is chiefly in the pelvic viscera, the rectal adminis- 
tration of the drug is always advisable by injection or by suppository. 

When pain is due to violent sciatica or to muscular spasm, it is 
best relieved by injecting the morphine directly into the subcutaneous 
tissues over the affected part. In other instances local pain due to 
superficial inflammation may be relieved by compresses wet with 
laudanum and lead-water. 

To patients who are prone to frequent attacks of pain opium must 
be given with the greatest caution, as the " opium-habit " is easily 
produced. 

Insomnia. — Opium, while capable of producing sleep in almost 
every case in which it is given, save in those individuals who by rea- 
son of idiosyncrasy are made wakeful by it, is only to be used in those 
instances where the sleeplessness is due to pain. If constantly used 
for the relief of insomnia or pain, the opium habit is rapidly contracted, 



362 DRUGS. 

and for this reason the use of this drug should be alternated with 
chloral, cannabis indica, and other soporific drugs. 

In some cases chloral and morphine, when given in small doses in 
combination, will so act upon the brain as to produce sleep. Thus, 
in the following prescription, the dose of both active ingredients is 
much smaller than would be needed if either was used alone, yet the 
result sought by their use — namely, sleep — is readily produced: 

K — Morphinae sulph. . gr. ij (0.12). 

Chlorali hydrati #j (4.0). 

Svrupi f|j (30.0). 

Aquas dest ^ij (60.0).— M. 

S. — Dessertspoonful (8.0) at 9 p. m., and, if needed, again at 10 or 11 o'clock. 

In the persistent insomnia of typhoid fever, croupous pneumonia, 
and all acute diseases in which nervous exhaustion is due to lack of 
sleep, a hypodermic injection of morphine will sometimes produce most 
excellent results, but the proper use of cold bathing is to be preferred 
for this purpose if it can be employed. (See Cold, Part III.) 

Inflammation and Irritation. — Opium seems to possess some 
influence over inflammation which we cannot explain, and both small 
and large doses are particularly valuable in inflammation of serous 
membranes, such as peritonitis, meningitis, and pericarditis. In 
peritonitis opium has been thought to be useful, but grave doubts 
are now entertained as to its value (See the article on Peritonitis in 
Part IV.) 

Opium allays the nervous excitement and cough following haemop- 
tysis, and the intense unrest caused by itching skin diseases, as, for 
example, the irritation of smallpox. 

Sometimes intense irritation or inflammation produces so great an 
effect upon unstriped muscular fibres as to cause spasm or paralysis, as 
in retention of urine, cystitis, or the constipation following inflamma- 
tion of the bowels due to the ingestion of irritating foods; under these 
circumstances the employment of opium is indicated, and is usually 
very successful. In irritative coughs morphine given in syrup of wild- 
cherry bark does good in the dose of -^ to -^ grain (0.005-0.006). 

In some cases of irritable cough due to a tickling sensation in the 
larynx, much relief can be had by inhaling the steam arising from a 
cup of boiling water in which has been placed a drachm or two of 
paregoric. 

Whenever cough is excessive — that is, greater than is necessary to 
free the lungs from mucus — morphine may be given in small doses. If 
the lungs contain more rales after its use than before, its use must be 
stopped, as the increase in the number of rales indicates an increased 
accumulation of mucus. 

In the treatment of strangury due to cystitis, and in rectal inflam- 
mation, provided they are not acute, and after operation on the pelvic 
organs, suppositories of the strength of \ to \ grain (0.015-0.03) 
of the watery extract of opium are useful. In excessive vomiting 



PLATE I. 




Chart showing the effect of opium in a ease of diabetes mel- 
litus. On the day of admission the patient was placed on a full 
house diet. The quantity of urine and fluid ingested at once 
increased. He then was placed on a restricted diet which caused 
a fall in the urine and fluids ingested but no decrease in sugar. 
Opium was now given and the sugar fell at once (see green 
line). Later on the house diet was resumed but the opium held 
the sugar in cheek. Note how the fluids increased on the 28th 
of May and how they fell when the opium was renewed and 
increased. The chart shows how the restricted diet governed 
the urinary flow and how the opium was needed to control the 
melituria. 



OPIUM. 363 

from any cause, except it be from a previous dose of opium, an 
enema of deodorized laudanum 30 minims (2.0) and starch-water 4 
ounces (120.0), with 40 grains (2.6) of bromide of sodium, will be 
found of value. (See Vomiting, Part IV.) 

In muscular rheumatism and similar states, and in the incipient 
stage of a "cold," opium in the form of Dover's powder in the dose 
of 5 to 10 grains (0.30-0.60) will often produce a cure, particularly if 
employed in combination with hot drinks and a hot foot-bath. Cam- 
phor can often be added to the Dover's powder with advantage. (See 
Coryza, Part IV.) 

For sprains and bruises lead-water and laudanum is one of the best 
applications. (See article on Lead.) If the skin is broken, the laud- 
anum may be used alone to relieve pain, and, by its alcohol, will act 
as an antiseptic. Opium is also a useful drug in the treatment of inter- 
nal and external bums to relieve the pain and irritation. 

Oversecretion. — In serous diarrhcea, diabetes insipidus and mel- 
litus, and in the treatment of oversecretion on the part of all secreting 
surfaces except the skin, opium may be used. 

Opium is said to decrease the amount of urine before decreasing the 
amount of the sugar in diabetes. However this may be, the employ- 
ment of opium or morphine or codeine in diabetes is a valuable 
form of treatment. The doses should be rapidly increased, as the 
effect is only obtained by ascending amounts, and diabetic patients 
seem peculiarly immune to the nervous influence of this drug and 
its alkaloids. Morphine is, therapeutically, the more powerful of the 
two alkaloids, but crude opium is more powerful for good in this 
affection than either. None of them, probably, cure the disease, 
but so modify it as to make life bearable, for the sugar is decreased 
in many cases, and the excessive hunger, thirst, and nervous irri- 
tability are relieved. Itching of the skin is also allayed in this class 
of patients by its use. (See Plate, and also article on Diabetes, 
Part IV.) The sudden withdrawal of opium from a case of diabetes 
may precipitate diabetic coma. 

Opium should not be used to arrest an attack of mucous diarrhoea 
until after the mucus which is already present in the bowel has been 
swept out of the intestinal canal by a dose of castor oil or magnesium 
sulphate. Minute doses of -£$■ to -g- 1 ^- grain (0.001) of morphine 
given hypodermically will sometimes check summer diarrh&a in chil- 
dren at once. (See article on Diarrhoea.) 

Morphine rather than opium is used to relieve pain because it does 
not cause so much constipation, but opium is better to check diarrhoea. 
Paregoric is particularly useful in diarrhoea because it contains a 
volatile oil and camphor. 

Systemic Strain. — In prolonged strain upon the system, as in 
great physical or nervous effort, or more frequently in old age to 
smooth the remaining years of life and decrease worry, opium is 
useful, but its use in young persons is most dangerous, as it is almost 



3G4 D'RUGS. 

certain to produce the opium habit. In asthenic fevers opium is thought 
to be supportive, but its use is apt to cause so many other conditions, 
such as constipation, anorexia, or mental depression, that alcohol is 
much better for this purpose. In advanced phthisis it is often 
justifiable to give sufficient opium to keep the patient free from pain 
and discomfort for the remaining hours of his life, but care must be 
taken that the dose does not interfere with the breathing and so hasten 
death. 

In heart disease, particularly of the mitral valves, the patient can 
often breathe easily only when awake, starting up when he falls asleep 
and gasping for breath. It is stated by some writers that morphine 
will relieve this state and permit sleep, but that it will not be of service 
in aortic disease. While this may be partly true, the drug will often 
give great relief in all forms of cardiac dyspn&a, and ought always 
to be tried with caution, although it is contraindicated if the heart 
has undergone fatty degeneration. Care should be taken that the 
first dose is small, as in some instances it increases the discomfort. 
The relief obtained is supposed to be due to cardiac stimulation by 
the drug, and this is no doubt correct, since the other cardiac stimu- 
lants, such as digitalis, will often fail when morphine succeeds. The 
presence of cyanosis and lividity is said to be no contraindication 
to the hypodermic use of morphine under these circumstances, pro- 
vided the dose is not unreasonably large, and provided these signs 
are purely circulatory in origin. If they are due to pulmonary 
oedema or diffuse bronchitis, it is unsafe. Not rarely in the course 
of pneumonia and typhoid fever a state of nervous restlessness with 
active talkative delirium develops, in which the patient may die from 
lack of sleep. At such times a hypodermic dose of morphine may be 
most useful and save life. The drug should be given hypodermically 
for these purposes in the dose of about \ grain (0.015). 

Opium and morphine, particularly the latter, have been freely 
given to produce quiet in patients with uremic convulsions. The 
practice is a dangerous one, and should not be resorted to as a rule, as 
the impaired state of the kidneys prevents elimination of the drug. 

Administration. — Recent studies upon the action of opium and its 
alkaloids show that it acts in an inhibitory manner upon gastric diges- 
tion and absorption, decreasing the amount of hydrochloric acid in 
the gastric juice. For this reason, unless there is an excess of acid 
present in the stomach, it is well not to give opium or morphine at 
meal times, but some time after. 

Opium itself is used in the form of the powder (Pulvis Opii, U. S.) 
and in granulated form (Opium Granulatum, U. S.) in the dose of 
from J to 2 grains (0.015-0.12). The solid preparations are the 
deodorized opium (Opium Deodoratum, U. S.), which is deprived of 
its narcotine, dose § to 2 grains (0.03-0.12); the pills of opium 
(Piiula Opii, U. S.), each containing 1 grain (0.05); and the watery 
extract (Extractum Opii, U. S. and B. P.), dose \ to \ grain (0.0.15- 
0.03). Of the liquid preparations we have paregoric (Tinctura Opii 



OPIUM. 365 

Camphorata, U. S. ; Tinctura Camphorce Composita, B. P.), dose 1 
drachm to 1 tablespoonful (4.0-16.0) ; laudanum (Tinctura Opii, U. S. 
and B. P.), dose 5 to 20 minims (0.30-1.30); the deodorized tincture 
(Tinctura Opii Deodorati, U. S.), dose 5 to 20 minims (0.30-1.30); 
Vinum Opii, U. S., or, as it is sometimes called, Sydenham's Lauda- 
num — dose 5 to 20 minims (0.30-1.30); and Acetum Opii, U. S., or 
Black Drop, dose 5 to 20 minims (0.30-1.30). 

As all the liquid preparations of opium in the U. S. P. are of 10 
per cent, strength, except paregoric, which is about 2 grains to the 
ounce, the dose of all of them except paregoric is identical. This is 
a fact to be remembered by students. 

Under the name of Dover's Powder (Pulvis Ipecacuanha et Opii 
U. S.; Pulvis Ipecacuanha^ Compositus, B. P.), a powder containing 
1 part of powdered opium, 1 part of powdered ipecac, and 8 parts of 
sugar of milk, is largely used. The dose is 5 to 10 grains (0.3-0.60). 
It is more efficacious if separated into fifths and taken in divided doses. 
The tincture of ipecac and opium (Tinctura Ipecacuanha et Opii 
U. S.) is given in the dose of 5 to 15 minims (0.3-1.0). 

The preparations of opium official in the B. P., other than those 
named, are Extractum Opii Liquidum, dose 4 to 20 minims (0.25-1.3) ; 
Pulvis Opii Compositus, composed of opium, pepper, ginger, caraway- 
fruit, and tragacanth, dose 2 to 5 grains (0.12-0.30) ; Tinctura Opii 
Ammoniata, dose h to 1 drachm (2.0-4.0). Pihda Saponis Composita, 
B. P., is really a preparation of opium. It is sometimes necessary 
to give this drug to patients without their knowledge, and it may be 
prescribed in this way, the patient not learning from the prescription 
the nature of the medicine. The dose is 2 to 4 grains (0.12-0.25). 

The B. P. also recognizes a liniment (Linimentum Opii) and a 
plaster (Emplastrum Opii) for local application. 

Untoward Effects. — When opium is given to some individuals it pro- 
duces for several hours marked wakefulness followed by sleep, and 
in many patients causes after its primary influence great nausea, and 
sometimes vomiting. The mental depression may be simply over- 
whelming, and the very fact of having to drag out existence is a curse. 
By far the most effective mode of preventing these very distressing 
effects of opium or its derivatives is to administer with this drug about 
27J-Q- grain of nitroglycerin. One of the chief causes, however, of the 
nausea produced by the use of opium or morphine is the change in the 
body of morphine into oxy-dimorphine, which is eliminated into the 
stomach and there reabsorbed, and then induces these secondary effects. 
It is also a fact that these symptoms can be largely relieved by the 
use of 20 grains (1.3) of bromide of potassium, which must be taken 
at the same time as the opiate, and by employing the preparations of 
opium largely devoid of narcotine, such as the deodorized tincture or 
deodorized opium itself. Whenever possible these preparations should 
be used to the exclusion of the others. Haig is responsible for the 
assertion that, as opium frees the blood from uric acid by causing its 



366 DRUGS. 

retention in the tissues of the body, the pleasant effects are so produced, 
and that, the retention being cumulative, no sooner does the effect of 
the opiate pass off than the uric acid is set free in the blood, and as a 
result depression ensues. He states that if salicylates are given with 
the opium retention does not occur, and the unpleasant sequelae are 
modified or prevented. After the untoward symptoms come on 
coffee and stimulants may be used with advantage to overcome them. 
In some persons the use of opium is followed by itching of the skin or 
by the development of an erythematous rash which may go on to 
desquamation. 

Children bear opium badly, and some children are very much more 
susceptible than others to its influence. 

One-eighth grain of morphine has caused death in an adult when 
given hypodermically, probably because it entered a vein. Sometimes 
the drug causes collapse, or in other cases an eruption upon the skin 
of the body. 

The use of repeated doses of morphine for several days often excites 
obstinate vomiting, due probably to the change of the drug into oxy- 
dimorphine or apomorphine. 

Codeine. 

(See p. 207.) 

Morphine. 

Morphina, U. S. and B. P., is the chief alkaloid of opium, but 
owing to its insolubility is rarely used, being generally given in the 
form of the sulphate. 

Sulphate of Morphine (Morphines Sulphas, U. S.) is given in the 
dose of J to \ grain (0.008-0.03), either by the mouth or hypoder- 
mically. Besides the sulphate of morphine we have the acetate 
(Morphine? Acetas, U. S. and B. P.), the hydrochloride (Morphine? 
Hydrochloridum, U. S. and B. P.), and the tartrate (Morphince Tar- 
tras, B. P.), all given in the dose of | to i grain (0.008-0.03). In the 
U. S. Pharmacopoeia of 1870 a solution of morphine was official, 
called Liquor Morphine Sulphatis (B. P.), dose 1 to 2 drachms (4.0- 
8.0) ; but it is no longer official and should not be called for. Magen- 
die's solution of morphine is sixteen times as strong as the liquor just 
named (16 grains to the ounce), and is also not official. The words 
" Liquor Morphinse Sulphatis" will often cause Magendie's solution 
to be dispensed in New York State, and care should be taken that 
poisoning does not result. Pulvis Morphina? Compositus, U. S., or 
Tully's Powder, is given in the dose of 10 grains (0.60). It contains 
sulphate of morphine, camphor, liquorice, and precipitated calcium 
carbonate. It is used to check forming colds and as a nervous 
sedative. Troches of morphine and ipecac (Trochisci Morphina et 
Ipecacuanha^) are given one or two at a time for irritation of the 
pharynx. 



OX-GALL. 3G7 

The following additional preparations of morphine are official in the 
B. P. : Liquor Morphine? Hydrochloridi and Liquor Morphine? Tartrates, 
dose 10 to 40 minims (0.60-2.6) ; Tinctura Chloroformi et Morphinoe 
Composiia, dose 5 to 10 minims (0.30-0.60) ; Suppositoria Morphine?, 
each suppository containing J grain (0.015) of morphine; Trochiscus 
Morphinoe and Trochiscus Morphine? et Ipecacuanha?, each lozenge 
containing -^ grain (0.002) of morphine, dose 1 to 4. Liquor Mor- 
phine? Acetatis is given in 20- to 40-minim (1.3-2.6) doses. Injectio 
Morphine? Hypodermica, B. P., contains 1 grain (0.06) of the tartrate 
of morphine in each 22 minims (1.4) of water. Its dose is 1 to 5 
minims (0.05-0.30). 

Incompatibles. — Morphine is incompatible with potassium perman- 
ganate and with tannic or gallic acid or solutions containing them; 
with alkalies, such as potassium, sodium, and ammonium salts, 
but with the chloride of ammonium it is not incompatible. With 
tincture of chloride of iron it forms a deep-red color (meconic acid). 

0RTH0F0RM. 

Orthoform is a colorless, bulky, odorless, and tasteless powder which 
is slightly soluble in water. It is used as a local anaesthetic and anti- 
septic dressing for small wounds and burns, and is said to be non-toxic, 
but this is an error. It may be applied in powder or ointment. The 
latter is usually of the strength of 2 drachms to the ounce of lanolin 
(8.0-30.0). It may be given by the stomach in cases of epigastric 
pain to determine its source. In cases of gastric ulcer it may relieve 
the pain, but if the pain be due to gallstones it will fail. 

OVARIAN EXTRACT. 

The ovarian gland , in the form of the dried gland substance or 
in that of an extract made from it, has been used for relief of the 
nervous and nutritional disturbances of the menopause, whether they 
be the result of age or of operative removal of these bodies. It is said 
to be most efficacious in those instances in which the ovaries have been 
removed from young women. As the use of the ovarian extract in 
medicinal doses seems to be harmless, it may be given for a long time 
without danger. The beginning dose should be 2 to 4 grains (0.12- 
0.25) a day, and this be gradually increased until some effect is 
produced or it proves useless. The best method of giving it is in 
compressed tablet or in capsule. Professional opinion as to its value 
is very contradictory. 

OX-GALL. 

Inspissated Ox-gall (Fel Bovis, U. S ) is, as its name implies, dried 
ox-bile, derived from the gall-bladder of the common ox (Bos Taurus). 
It is used in medicine for the purpose of relieving certain forms of 



368 DRUGS. 

indigestion which result from deficient secretion of bile or which occur 
in persons who digest fats with difficulty. In full doses it is apt to 
cause some looseness of the bowels, and it may be given with the object 
of producing this condition. When it is used, the fact should be remem- 
bered that bile prevents the gastric juice from acting upon proteid 
or albuminous substances, shrivelling them up, and in addition so 
alters the gastric liquids as to decrease their digestive power. We 
know, therefore, that this drug must be administered some hours after 
meals, as a rule, or, in other words, when gastric digestion is ended 
and intestinal activity is beginning. The dose of inspissated ox-gall, 
which is dried by evaporation from 100 to 15 parts, is 5 to 15 grains 
(0.30-1.0). Purified Ox-gall {Fel Bovis Purificatum, U. S.; Fel 
Bovinum Purificatum, B. P.) is given in the same dose as the inspis- 
sated bile. It is made by evaporating 3 parts of pure ox-gall to 1 
part, and then adding to this part an equal amount of alcohol, which 
constituents are mixed thoroughly, and after standing twenty-four 
hours the clear liquid is decanted and the residue evaporated to a 
consistence capable of forming a pill. 

OXIDE OF ZINC. 

Commercial Oxide of Zinc (Zinci Oxidum Venale) is not used 
in medicine, but in the purified form is largely employed as 
Zinci Oxidum, U. S. and B. P., which is insoluble in water. In 
the form of the oxide-of-zinc ointment (Unguentum Zinci Oxidi, U. S. 
and B. P.) this drug affords one of the most generally used applica- 
tions in the treatment of skin diseases, burns, and sores. 

In all states where the surface of the skin is dry it is contraindi- 
cated, but where the eruption is moist it is useful. In the treatment 
of the chloasma of pregnancy the following prescription is of service: 



gr. iij (0.2). 
gr. j (0.06). 
3ijss (10.0). 
5ijss (10.0). 
gtt. x (0.60).— M. 



1$ — Zinci oxidi . 

Hydrarg. ammoniat. 
Olei theobromse . 
Olei ricini 
Essent. rosse 
S. — Apply to the face night and morning. 

In eczema with many vesicles use — 

1$ — Pulv. camphorse 5ss (2.0). 

Pulv. zinc, oxidi 3iij (12 0). 

Glycerini gtt. xl (2.60). 

Adipis benzoinati Bj (30.CT). — M. 

S.— Apply to the part without other treatment or precede it by powdered bismuth. 

Unna's Dressing (composed of gelatin 4 parts, water 10 parts, 
glycerin 10 parts, and zinc oxide 4 parts) is a useful application 
for ulcers and eczematous patches on the legs or arms. It is par- 
ticularly useful for leg ulcers. The gelatin and cold water are put 
in a basin over a fire and a solution made; then the glycerin is added, 



OXYGEN. 3G9 

and then the oxide of zinc is slowly added, with constant stirring. 
After the mixture is complete it is poured into a can and allowed to 
cool, when it is ready for use. This application decreases swelling 
and is soothing and supporting. It is applied as follows: The part 
affected is well washed with water and soap, and then with alcohol. 
The paint having been warmed and melted, a large three-inch paint- 
brush is used to apply a coating to the limb all around the ulcer, and 
over this a single layer of gauze is applied. The gauze bandage should 
be two inches wide. The bandage must be laid on evenly and the 
ulcer covered by a pad of absorbent cotton. After one layer is applied 
it is cut and another coat of paint applied over it. Then another 
layer of gauze and another of paint are used, until several layers are 
in place. It is best to begin at the toes and work up toward the knee. 
All parts should be equally well covered. Finally the entire dressing 
is covered by a cotton roller bandage, which is removed in twenty- 
four hours, leaving what looks like a white rubber dressing on the limb. 
If the liquid from the ulcer oozes through the dressing profusely, a 
window is to be cut over the ulcer, and it can be locally treated by astrin- 
gents or other measures. The patient should keep the limb elevated 
for a day or two, but can then walk with far more comfort than if a 
rubber supporting bandage is used. 

In powdered form zinc oxide is useful in the treatment of intertrigo 
and for conjunctivitis. Mixed with bismuth subnitrate and pepsin, it 
is largely used by some practitioners in the treatment of the summer 
diarrhoea of infants or adults 

In the night-sweats of debility or of 'phthisis oxide of zinc in the 
following formula has been highly recommended, but the prescription 
probably depends largely for its action on the second ingredient: 

^— Zinci oxidi gr. xxx (2.0). 

Extract, belladonna? . . . . . . gr. iij (0.20).— M. 

Ft. in pil. No. x. 

S. — One at night before going to bed. 

Bartholow recommended the oxide of zinc for asthma and whoop- 
ing-cough, given to an adult in the manner just indicated. 

OXYGEN, 

The gas Oxygen is now widely used in medical and surgical practice 
in three ways, as follows: By the inhalation of the gas itself from a 
cylinder in which it is compressed until 40 gallons occupy a very small 
space; by drinking oxygen-water, which is distilled water saturated 
with the gas; and finally, by the use of the dioxide or peroxide of 
hydrogen, which is applied locally to diseased surfaces. (See Hydrogen 
Peroxide.) • ' 

Inhalations of oxygen are useful in the second and third stages 
of pneumonia where the patient seems about to die from deficient 

24 



370 DRUGS. 

aeration of the blood, with resulting heart-distention. They are also of 
value in advanced bronchitis, particularly that of old persons, and for the 
resuscitation of individuals asphyxiated by coal-gas (Hare and Martin). 
In phthisis and other exhausting diseases oxygen will allay dyspnoea 
and oppression. Oxygen inhalations are also of service in the treat- 
ment of anosmia in all its forms and give relief even in pernicious 
anosmia and in leukosmia. Often a mixture of oxygen gas 60 parts 
and nitrous oxide gas 40 parts is used as a stimulant inhalation and 
nervous sedative. 

The clinical results which have so far been obtained from the admin- 
istration of ether and chloroform vapor when combined with oxygen 
gas seem to prove beyond all doubt that the oxygen decreases the 
danger of the anaesthetic and to a large extent obviates the difficulties 
which attend the administration of these drugs, and most of the 
untoward effects which result from their use. Thus, when oxygen 
is given with ether, vomiting is less frequently met with, excessive 
pallor is rarely seen, and post-operative depression seems to be 
largely avoided. 

As a general rule, however, it has been the custom of physicians 
and surgeons who have employed oxygen gas in combination with ether 
or chloroform, to place the anaesthetic in a wash-bottle and then to 
allow the oxygen gas to pass through it in such a way that the patient 
received in the inhaler a mixture of anaesthetic vapor and oxygen, the 
mixture resulting from the passage of the oxygen gas through the 
liquid anaesthetic in the bottle. An evident disadvantage of this 
arrangement is that the quantity of anaesthetic which is volatilized 
can only be in direct proportion to the volume of oxygen gas which is 
forced through the wash-bottle, and therefore with every increase in the 
quantity of vapor which the patient receives he must also receive an 
increased quantity of oxygen. It has been claimed, too, by those who 
have employed the ether and oxygen combination most frequently, that 
in a large proportion of cases a greater length of time is required 
for the anaesthetizing of the patient, and that in some cases it seems 
almost impossible to get the patient under the direct influence of the 
drug. This difficulty lies in the fact that as soon as a large quantity of 
oxygen gas is used to convey a large quantity of anaesthetic vapor to 
the lungs, the patient rapidly passes into a condition which is called by 
physiologists apncea. The respiratory centre is no longer irritated by 
the normal proportions of carbonic acid in the blood, and therefore 
sends out feeble respiratory impulses; and as the patient does not 
breathe so rapidly or so deeply as before, the result is that very small 
quantities of the anaesthetic are taken into the body. 

The apparatus which the author has employed with success, and 
which he suggests as a substitute for the one heretofore employed, con- 
sists of a somewhat funnel-shaped piece of leather having a greater 
diameter in one direction than in another, and into which is fitted as an 
inner lining a piece of soft felt or spongiopiline almost a quarter of 



PANCREATIN AND PANCREATIC EXTRACTS. 371 

an inch thick. In the under surface of the leather cone is inserted a 
small metal tube, and at the opening of this tube a small hole is cut in 
the spongiopiline. The ether is poured upon the spongiopiline in 
the cone, in the apex of which is placed some absorbent cotton. The 
oxygen enters the cone by means of a rubber tube attached to the metal 
entrance which has been mentioned. By this arrangement several 
objects are accomplished. In the first place, the supply of oxygen can 
be delivered to the patient in varying quantities without altering the 
amount of anaesthetic which is being given. In the second place, any 
quantity of anaesthetic can be employed without necessarily increas- 
ing the oxygen. Thirdly, the leather cone prevents the rapid evapora- 
tion of ether from the outer side of the spongiopiline. And fourth, 
the spongiopiline, being much more porous than an ordinary towel, 
will retain a large quantity of ether in liquid form when this drug is 
poured upon it. Finally, if desired, the same apparatus can be used 
for the administration of chloroform by removing the metal cap on 
the smaller end of the cone, as in this way the patient will receive not 
only the anaesthetic vapor and the oxygen, but also fresh air through 
the end of the cone, in such quantities as the physician deems wise. 
In these cases it is best to use the attachment known as the Krohne 
and Sesemann "respiration-indicator," which consists of a small 
feather on a pivot which moves to and fro with the motions of respira- 
tion, thereby providing the physician with a gauge as to the rapidity 
and force of the respiratory movements. The soft felt is very cheap, 
and a new piece can be used for each patient. 

In conclusion, the writer cannot condemn too strongly the method 
of employing chloroform vapor and oxygen by passing the oxygen 
directly through the chloroform without the free administration of air 
in addition, for, after all, air is what we are intended to breathe, and 
not oxygen gas alone, although it may be advantageous at times to add 
an increased quantity of oxygen to the air. 

Still more severe condemnation should be directed toward the attach- 
ment which is placed on some of the Junker inhalers, and which con- 
sists of a small rubber bag which, instead of acting as a reservoir of 
fresh anaesthetic vapor and oxygen, is inflated and collapsed by the 
expiration and the inspiration of the patient, who does not receive even 
fresh oxygen and anaesthetic vapor, much less fresh air, but, on the 
contrary, inhales again and again air, oxygen, and vapor which are 
loaded with the impurities of frequent expiratory efforts. 

(For the directions for using oxygen with nitrous oxide as an anaes- 
thetic see the article on Nitrous Oxide.) 

PANCREATIN AND PANCREATIC EXTRACTS. 

Under these names a number of firms now sell an extract from the 
pancreatic gland or juice, and the U. S. P. recognizes such a product 
under the name of Pancreatinum, Pancreatin should convert 25 



372 DRUGS. 

times its own weight of starch into substances soluble in water (U. S.). 
It contains, or should contain, the four pancreatic ferments — trypsin, 
which digests proteids (meat, eggs, etc.) ; steapsin, which splits up and 
emulsifies the fats; amylopsin, which has diastatic power (that is, 
converts starch into sugar), and finally a milk-curdling ferment. 

Pancreatin may be made by the physician in the following manner: 

Take the pancreas of a pig which has been killed about six hours 
after a full meal, the organ being therefore active, and, after chopping 
it finely, add to it four times its weight of dilute alcohol and allow 
it to stand for twelve hours. Decant or filter off the alcohol, and 
give the filtrate in the dose of 1 to 2 drachms (4.0-8.0). Or, better 
still, as follows: Wash and chop finely a fresh pancreas, and allow 
the gland to soak in alcohol (absolute) twenty-four to forty-eight hours. 
Then squeeze out the alcohol and add to the gland ten times its 
weight of glycerin. The mixture must stand forty-eight hours and 
then be filtered, and may be used in doses of 30 minims (2.0) to each 
glass of milk. (For the use of pancreatin in artificial digestion see the 
article on Peptonized Foods in Part III.) 

Pancreatin, as prepared for the market, is a dry powder, given in 
the dose of 2 to 20 grains (0.12-1.3) after meals or during them. 

Pancreatin should usually be prescribed with bicarbonate of sodium 
to aid it in its digestive action. It is indicated in all cases of lienteric 
diarrhoea and in many cases of deficient digestion. Pancreatin, or the 
powdered pancreas, may also be freely used in those cases of diabetes 
mellitus in which the disease depends upon a lesion of the pancreatic 
gland, as carcinoma or atrophy from other cause. 

Some doubt has been cast upon the usefulness of the employment 
of pancreatin in foods unless this ferment was allowed to act upon the 
aliment before it was swallowed by the patient, on the ground that 
pancreatin is destroyed and rendered inert in the presence of the acid 
which it meets in the stomach. This objection is not a valid one, 
because food remains in the stomach for from fifteen minutes to half 
an hour before enough gastric juice is secreted to interfere with the 
pancreatic action. It is during this preliminary period that the work 
of the pancreatin is accomplished. 

Pancreatized or peptonized foods should not be employed unless 
really needed, nor continued for any length of time, as digestion is 
finally impaired by torpor of the glands arising from disuse. 

The B. P. recognizes a solution (Liquor Pancreatis); dose 1 to 2 
drachms (40-8.0) . 

The dose of pancreatin is from 2 to 20 grains (0.12-1.3). 

PAPAIN, PAPAYOTIN, AND PAPOID. 

Papain, Papayotin, and Papoid are names given to a digestive fer- 
ment derived from the juice of Carica papaya. This ferment pos- 
sesses the power of changing proteids into peptones in the presence 



PEPO. 373 

of an acid or an alkali, or even in a neutral mixture, thereby differing 
from pepsin and pancreatin. This power would be of great value, 
since the drug would then be useful in all forms of dyspepsia, were 
it not that careful experimentation renders it doubtful whether 
papain, papayotin, or papoid can really supplant either of the animal 
ferments named above. The dose of all these products is from 1 to 
8 grains (0.06-0.50) given in solution, or better in pill. The plant 
itself, taken internally, has the reputation of being capable of causing 
abortion. 

PARALDEHYDE. 

Paraldehydum, U. S. and B. P., is a form of aldehyde used as a 
soporific and nervous sedative, and is a clear, colorless liquid with an 
ethereal odor and a burning, followed by a cool, taste. It should be 
kept in dark, well-stoppered bottles in a cool place. Paraldehyde is 
readily soluble in alcohol, moderately so in cold water, less so in hot 
water. It possesses the great disadvantages of being necessarily given 
in large dose and of having a disagreeable taste and odor. It is also 
very apt to disorder the stomach. Paraldehyde kills by respiratory 
failure when taken in overdose, but is not so depressant to the heart 
as is chloral. The drug soon loses its power as a soporific. The dose 
is 20 minims to 1 drachm (1.3-4.0) in capsule, or, better still, it may 
be used, after the formula of Yvon, as follows: 

3— Paraldehyde gijss (10.0). 

Alcoholis (90 per cent.) . . . . . f§jss(45.0). 

Tincturse vanillse f5ss(2.0). 

AquEe destillat foj (30.0). 

Syrupi q. s. ad fgiv (120.0).— M. 

S. — A dessertspoonful (8.0) every half -hour until sleep is obtained. 



PAREIRA. 

Pareira, U. S. (Pareirce Radix, B. P.), is the root of Chondoden- 
dron tomentosum, a plant of Peru and Brazil, and is used as a diuretic 
of an alterative or stimulant character and for the relief of chronic 
inflammations of the genito-urinary tract in general, such as pyelitis, 
cystitis of a subacute type, and similar pathological states. The dose 
of the unofficial infusion is a wineglassful (30.0), and the fluid extract 
(Fluidextractum PareircB, U. S.) is given in the dose of a teaspoonful 
(4.0) three times a day. The B. P. preparation of this drug is Ex- 
traction Pareirce Liquidum, dose 1 to 2 drachms (4.0-8.0). 

PEPO. 

Pepo (Cucurbita pepo), U. S., Pumpkin-seed, the seed of the ordinary 
domestic pumpkin, is a useful and efficient vermifuge for the tape- 
worm. The seeds are not only efficient, but are harmless to the host 



374 DRUGS. 

of the worm. The outer coverings of the seeds should be removed, 
and the remaining part rubbed up into an emulsion with water or into 
an electuary with sugar, the dose of the seed being 2 ounces (60.0). 
This mass should be taken on an empty stomach, and followed in 
from one to two hours by an active purge. 

PEPPER. 

Piper, U. S., or Black Pepper (Piper Nigrum, B. P.), is the unripe 
fruit of Piper nigrum, a vine of India, Java, Borneo, and Siam. It 
contains a neutral principle, piperin, which is official. 

Therapeutics. — Black pepper may be used externally as a counter- 
irritant or internally as a carminative and stimulant to the alimentary 
canal. 

It may also be used in all cases of atony of the mucous membranes 
of the genito-urinary system, but is contraindicated whenever acute 
inflammation is present, as in acute gonorrhoea. It may be used 
with marked relief in the treatment of intestinal flatulence. 

Piperin (Piperina, U. S.) has been used as an antiperiodic with 
varying success, and is given in the dose of 1 to 5 grains (0.06-0.3). 
The oleoresin of pepper (Oleoresina Piperis, U. S.) is given in the 
dose of J to 2 minims (0.015-0.1) in laxative pills, to prevent griping. 
A confection (Confectio Piperis) is official in the B. P., given in the 
dose of 1 to 2 drachms (4.0-8.0). 

PEPPERMINT. 

Mentha Piperita, U. S., is official in the form of the leaves and 
tops of Mentha piperita. It has an aromatic odor and taste and con- 
tains an oil. Locally applied, the oil acts as an irritant and local anaes- 
thetic. From this oil is obtained menthol, a camphoraceous substance 
of a hot, burning taste, possessing marked power as a local anaesthetic. 
(See Menthol, below.) 

Therapeutics. — Peppermint is used very largely as a domestic rem- 
edy for flatulence and infantile colic. Sometimes the oil is added to 
purgative pills to prevent griping, and it may be employed to disguise 
the taste of any medicines which are disagreeable to take. In this 
respect it is used as are all the volatile oils. In the colic of children of 
six months to a year of age, when it is unusually severe and associated 
with nervous symptoms, the following will be found of value: 

fy— Chloralis gr. xvj (1.0). 

Potassii bromidi gr. xxxij (2.0). 

Aq. menth. piperit . . fgij (60.0). — M. 

S — Teaspoonful (4.0) in a little warm water every four hours. 

When used in the treatment of neuralgia, oil of peppermint should 
be placed on a piece of linen or muslin rag and applied over the affected 



PEPPERMINT. 



375 



spot. Care must be taken that it does not blister the skin. If, after 
its removal, the burning is too severe to be borne, a little cosmoline 
or olive oil should be applied. Oil of peppermint is sometimes placed 
on cotton and inserted into dental cavities for toothache. 

It is to be remembered that the more menthol is present in the oil 
the more active will it be as an anaesthetic, and that the Chinese oil 
contains more menthol than the American oil. 

Administration. — Peppermint is used in the form of the oil {Oleum 
Menthoe Piperita, U. S. and B. P.), dose 1 to 4 minims (0.05-0.25); 
the spirit {Spiritus Menthoe Piperita, U. S. and B. P.), dose 10 to 
30 minims (0.60-2.0); the water {Aqua Mentha Piperita, U. S. and 
B. P.), dose 1 to 2 drachms (4.0-8.0; and, finally, as the Troches 
( Trochisci Mentha Piperita) , to be held in the mouth in indefinite 
number. 

Menthol. 

Menthol, U. S. and B. P., or Mint Stearopten, or, as it is called, 
Mint Camphor, is derived chiefly from the essential oil of pepper- 
mint. It occurs in colorless prismatic 
crystals with a strong odor of pep- 
permint. Upon it rests much, if not 
all, of the therapeutic activity of pep- 
permint. Menthol is slightly soluble 
in water, very soluble in alcohol, 
ether, and in oils. 

Menthol has been used in the 
vomiting of pregnancy with great 
advantage in hourly doses of a tea- 
spoonful of the following: 



Fig. 53. 



1^— Menthol . . 
Spt. frumenti 
Syrupi 



gr. xv (1.0). 
f5vj (24.0). 
m (30.0). 




Menthol has also been used as a 
carminative and in gastralgia in the 
dose of from 1 to 2 grains (0.06-0.12) 
three times a day in pill or in alco- 
holic solution. It is contraindicated 
in acute inflammation of the gastric 
mucous membrane. 

As menthol exercises a local anaes- 
thetic effect on the skin as well as on 
mucous membranes, it is used exter- 
nally over the course of neuralgic 
means of menthol pencils. 

Menthol when applied to the mucous membrane of the throat or 
nose causes a contraction of the local bloodvessels, which is not fol- 
lowed by the excessive dilatation produced by cocaine. In acute 



Nebulizer. The small pump on the right 
side forces air through the black tube in the 
glass jar. This air escapes from an aperture 
in the side of the tube and draws up the 
medicated liquid, which is then driven 
forcibly against the side of the glass. The 
finely comminuted fluid then passes as a 
vapor through the exit tube. 



nerves 



and for migraine by 



376 DRUGS. 

coryza its local application to tHe mucous membrane by a spray or 
dropper is often a source of great relief in a solution of about 1 grain 
(0.06) to the ounce (30.0) of water, or 3 grains (0.20) of menthol in 
\ ounce (16.0) of albolene. (See Coryza, Part IV.) 

Another very useful method of applying menthol is by means of a 
simple inhaler consisting of a small glass tube of about one-quarter of 
an inch in diameter and two and a half inches in length. Both ends 
are closed by a piece of gauze and two perforated corks, the menthol 
being placed in between. The air is now drawn through this tube, and, 
being heavily loaded with the fumes, clears the nares and relieves the 
stuffiness. It is not to be only smelled, but also inhaled. Care should 
be taken that the crystals are not allowed to enter the nostrils, as they 
are almost cauterant in power. Sometimes, where great excoriation 
of the alse of the nose exists, the too persistent use of the menthol 
may produce small herpetic spots about the nostrils. When menthol 
is inhaled for a long time or swallowed in any quantity it is apt to pro- 
duce severe congestive headache. 

Still another method is by the use of a nebulizer. (Fig. 53; also 
article on Inhalations, Part III.) The following mixture is placed in 
the glass jar, and the air being driven through the tube a vapor of 
the drugs is given off which is a valuable sedative to the entire respir- 
atory tract: 



-Chloretone . 
Menthol. . . 
Camphor. 
01. cinnamomi 
Petrolat. liquid. 



gr. ij (0.12). 
gr. xx (1.3). 

gr. xx (1.3). 

Ttlij (0.10). 
fgj(30.0).-M. 



S. — Use in a vaporizer every three hours for a period of about ten minutes. 

Sometimes menthol in 50 per cent, alcoholic solution is dropped on 
the cone with which ether is given, to diminish the irritation caused 
by that drug when it is inhaled. 

Menthol vapor is also useful in spasmodic croup. (See Part IV.) 
Emplastrum Menthol, B. P., is used as a mild local irritant and 
anaesthetic. 

PEPSIN. 

Pepsinum, U. S. and B. P., is the digestive ferment of the gastric 
juice. That sold in the shops is generally derived from the pig, and 
is prepared by manufacturers in many ways. Much of the pepsin 
of the market contains more peptone than pepsin, and much mucus 
and albumin. Used with hydrochloric acid in weak solution, pepsin 
carries out the digestive action of the stomach. Pepsin containing 
peptone has the peculiar musty smell of peptone, and if the peptone 
is in excess will absorb moisture and become sticky on exposure to 
the air. 

According to the U. S. P. official pepsin must have the power to 
digest three thousand times its weight of albumin. 



PERMANGANATE OF POTASSIUM. 377 

Therapeutics. — Pepsin is a much over-rated remedy for indigestion, 
which in many cases is due to hepatic disorder or to actual disease of 
the stomach which it cannot relieve. Pancreatin will nearly always 
be found more serviceable, and should be given either during or one 
or two hours after meals. Pepsin should be used immediately after 
the food is taken or with it. Hydrochloric acid should always be given 
with pepsin to aid its action, and because it converts the pepsinogen 
in the gastric tubules into pepsin. Liquor Pepsini is given in the dose 
of 2 drachms (8.0). Pure pepsin should be given in 5- to 15-grain 
(0.30-1.0) doses. A glycerite (Glycerinum Pepsinum) is official in 
the B. P. 

Very useful and readily taken liquid preparations are Pepsin 
Essence and Cordial, which are given in the dose of 1 to 2 drachms 
(4.0-8.0) after meals. A nutritious article of diet can be made by 
adding one teaspoonful of either of these liquids to a half-pint of 
warm milk, and allowing it to cool, thereby forming " curds and 
whey" through the action of the milk-curdling ferment.. (See 
Part III.) 

PERMANGANATE OF POTASSIUM. 

Potassii Permanganas, U. S. and B. P., is a salt of a dark purplish- 
red color, appearing in small crystals and readily soluble in water. 
In the presence of moisture it rapidly gives up the oxygen which it 
contains and becomes the binoxide of manganese. 

By reason of this oxidizing power the permanganate of potassium 
is useful as an antiseptic and deodorant. It should not be employed as 
a disinfectant for filth, because its action is too fleeting, but in satu- 
rated solution, followed by oxalic acid solution, it proves itself one 
of the best disinfectants for the hands in surgical practice. (See Anti- 
sepsis.) 

Permanganate of potassium is given in the same dose for amenor- 
rhcea as the binoxide of manganese, but is much less efficacious. It 
is also very apt to irritate the stomach. 

The permanganate is thought to be useful in dyspepsia, flatulence, 
lithamiia, and obesity, and in the first two states is often of service, 
being a destroyer of the abnormal products by oxidation. Owing to this 
oxidizing power, it has been asserted, by Weir Mitchell and Reichert, 
to be the most efficient antidote to snake-venom if placed in the wound 
before the poison is absorbed. It should also be injected hypodermic- 
ally about the seat of the bite. Permanganate of potassium is the best 
chemical antidote in poisoning by morphine and in that caused by 
many other vegetable alkaloids. It is also a good chemical antidote 
in phosphorus poisoning. Owing to its rapid evolution of oxygen 
it acts as an antiseptic, and may be used to wash wounds, ulcers, 
and sores, and as a lotion in the form of a gargle or on a swab in the 
sore throat of diphtheria and scarlet fever. The solution used should 
be from 20 to 60 grains (1.3-4.0) to the pint (480 c.c.) ; the former is 



378 DRUGS. 

used on mucous membranes, the latter for sores and wounds. In fetid 
rhinitis and otitis media permanganate solution is useful as a wash 
in the proportion of 1 grain (0.06) to the ounce (30.0). When given 
in solution permanganate of potassium should be dissolved in distilled 
water, and it should never be mixed in a mortar with any organic 
matter, as it will explode. A solution (Liquor Potassii Permangana- 
tis) is official in the B. P. 



PETROLATUM. 

Under the name of Petrolatum, U. S., or Soft Petrolatum, or Un- 
guentum Petrolei, is sold a semisolid substance derived from certain 
kinds of petroleum, and sometimes called Cosmoline or Vaseline. 

Owing to its soothing powers and non-rancidity, it is used as an 
emollient dressing in sores and skin affections. It has no value except 
as a protective, and may be given in capsule in cases of gastrointes- 
tinal irritation in any quantity as a soothing treatment. It does not 
affect the passages from the bowels and is not absorbed, although 
assertions to the contrary have been made. 

Cosmoline is a useful ointment base for medicaments for the skin. 
Under the name of fluid or liquid petrolatum (Petrolatum Liquidum, 
U. S.) a fluid form is sold, which is much used in the form of a spray 
in the treatment of rhinitis and after irritant applications to the nasal 
cavities. 

Petrolatum Album (U. S.), or White Petrolatum, is a purer product, 
being devoid of coloring matters. 

PHENACETIN. 

Phenacetin (Acetphenetidinum f U. S. ; Phenacetinum, B. P.) is a 
coal-tar product introduced several years ago as an antipyretic of the 
same character as an ti pyrin. It occurs in white, glistening, crystal- 
line scales without odor or taste, and, while more apt to disintegrate 
the blood than some of the other drugs in its class when given in 
large amounts, is not very dangerous, because its influence upon 
other vital parts is not severe. It is only slightly soluble in water. 
Acetanilid and antipyrin are sometimes substituted for phenacetin. 
Pure phenacetin when shaken with nitric acid is colored yellow, 
which color persists when it is heated. This is not the case with the 
other products named. 

When this drug is carelessly made, an impure product is the result, 
which produces irritation of the kidneys, and, in consequence, causes 
grave complications. Reuter states that the impurity may be dis- 
covered by placing a small amount of chloral hydrate in a test-tube, 
melting it at a temperature just sufficient to liquefy it, and then 
adding the suspected sample of phenacetin in the proportion of one- 



PHENACETIN. 379 

fifth. If the phenacetin is impure, it will become purple, then red, 
and finally blue. 

Physiological Action. — Unfortunately, our knowledge of the physio- 
logical action of phenacetin upon the nervous system is not so thor- 
ough as is desirable. We know, however, that it is a distinct nervous 
sedative, and that it acts particularly on the spinal cord in its sensory 
tracts. 

Upon the circulation the drug has little or no effect unless given 
in doses exceeding, those generally employed or continued in overdose 
for some time. The blood after the ingestion of these doses becomes 
dark and blackish from the formation of methsemoglobin, and the 
urine becomes dark yellow and reacts with Fehling's solution. Upon 
normal bodily heat and the heat of fever the drug exerts a depress- 
ing effect, decreasing the production and increasing the dissipation 
of heat. 

Therapeutics. — Our knowledge concerning the influence of phen- 
acetin upon the human body in disease may be divided into two sepa- 
rate parts in much the same manner that we divide the uses of anti- 
pyrin — namely, its uses as an antipyretic and as an analgesic. 

Like the other members of the antipyretic group which possess this 
double action, its antipyretic influences were first observed, and will 
therefore first be spoken of. 

The employment of this drug in medicine was first attempted by 
Hinsberg and Kast, who from the very first spoke of it in the highest 
terms of praise. They found that it seldom, if ever, caused serious 
untoward effects, and that its power over fever, in the dose of from 
3 to 8 grains (0.20-0.5), was extraordinary. Shortly after the paper 
of these writers appeared Kohler published the report of its use in 
some fifty cases in the clinic of Bamberger, of Vienna. He found, as 
have most of his successors, that the fall of fever does not occur for 
nearly half an hour after the dose is taken, and that the stage of 
apyrexia continues for from four to eight hours afterward. 

As a general rule, sweating is not noted as being present to any 
great extent, but in phthisis and advanced typhoid fever there can be 
no doubt that chilliness and an abnormal fall of temperature may 
come on under its influence. Cyanosis and vomiting did not occur in a 
single one of Kohler's cases. 

The remarks made in the article on Fever (Part IV.) clearly show 
why phenacetin should not be used as an antipyretic, for all antipyretic 
drugs are, as a rule, deleterious. It is far better to reduce the fever 
with cold applications. (See Cold in Fevers, Part III.) 

Upon the nervous system phenacetin acts as an antineuralgic, and is 
of service in migraine and ordinary headache from eye-strain, in the 
pains of tabes dorsalis, in intercostal neuralgia, and in rheumatism. 
Sometimes it cures these troubles when antipyrin fails. Altogether, 
we may consider phenacetin a rival of antipyrin in the power to relieve 
pain. 



380 DBUGS. 

For neuralgia the following prescription may be ordered : 

J£ — Phenacetin gr. x (0.60). 

Caffeinse citratse gr. v (0.30). 

Sacchar. lactis gr. xx (1.3). — M. 

Ft. in chart No. v. 

S. — One or two powders every two hours while the pain lasts. 

In subacute rheumatism and in the lumbar or muscular pains of 
influenza a powder or pill of 4 grains (0.25) of phenacetin and 5 grains 
(0.30) of salol given three or four times a day is most efficient. 

Under the name " Lactophenin," a nearly related compound of 
phenacetin is sometimes used for the same purposes. In phenacetin 
one atom of hydrogen is replaced by an acetic-acid radicle; in lacto- 
phenin this atom of hydrogen is replaced by a lactic-acid radicle. 
Similarly "citrophen" is made by replacing the atom of hydrogen by 
a citric-acid radicle. It is also used as a substitute for phenacetin. 

The dose of these drugs is about the same as that of phenacetin, 
or a little larger, about 5 to 10 grains (0.30-0.60) three times a day. 



PHENOCOLL. 

Phenocoll is a compound closely allied to phenacetin. It is always 
used in the form of the hydrochloride of phenocoll, which occurs in a fine 
white powder, and which is soluble in water and forms a neutral solu- 
tion. It is incompatible with alkalies, and is used as an antipyretic. 

Physiological Action. — A number of studies of the action of phe- 
nocoll hydrochloride upon the animal organism have been made by 
Kobert and von Mering in Europe, and by Wood and Cerna and 
Ott in America. These investigators have found that it is differ- 
ent from most of the coal-tar antipyretics in that it has little effect 
on the red blood-corpuscles. It does not cause so great a sweat when 
the fever falls as do its near antipyretic relatives. Von Mering has 
shown that phenocoll has little lethal power, but Ott asserts that in 
poisonous dose it kills by failure of respiration, and causes paraplegia, 
cyanosis, and depression of the heart. 

Therapeutics. — As pointed out in the article on the treatment of 
Fever, antipyretic drugs are of little value as compared to bathing. 
Phenocoll may be given for the same purpose and under the same 
circumstances in the presence of fever as antipyrin or acetanilid, 
but, like these drugs, is contraindicated in advanced exhausting dis- 
eases, such as consumption. A number of clinicians have tried pheno- 
coll hydrochloride for the relief of acute rheumatism and neuralgic 
pain, with asserted success. The dose of phenocoll hydrochloride is 
5 to 8 grains (0.30-0.50) two to five times a day. It is best given in 
capsule. 

PHENOL. 

(See Carbolic Acid.) 



PHOSPHATE OF SODIUM. 381 

PHENOLSULPHONATES OF ZINC AND SODIUM. 

The phenolsulphonates of zinc (Zinci Phenolsulpkonas, U. S., 
Zinci Sulphocarbolas, B. P.) and sodium (Sodii Phenolsulpkonas, 
U. S., Sodii Sulphocarbolas, B. P.) are largely employed by some 
practitioners as mild antiseptic local stimulants, either in powder or 
in solution, on ulcers and sores. Much more commonly they are given 
internally for the production of gastro-intestinal antisepsis when there 
is diarrhoea with fetid, ill-smelling stools, as in the bowel disorders of 
hot weather in children or adults, or in the course of typhoid fever. 
How much good they do in the latter disease, so far as the disease itself 
is concerned, is uncertain, but they undoubtedly render the stools less 
foul and tend to check the diarrhoea. The phenolsulphonate of zinc is 
the better of the two for these purposes. The dose is 2 to 3 grains 
(0.12-0.20) in pill four or five times a day. The phenolsulphonates 
are probably eliminated from the body unchanged. Sometimes good 
results follow the use of cascara sagrada with these salts in cases of 
constipation with flatulence and signs of autointoxication. 

PHOSPHATE OF SODIUM. 

Sodii Phosphas, U. S. and B. P. is a preparation which has been 
used with the idea that it can supplant phosphorus. This is, of course, 
an error, as it has an entirely different effect. It is particularly useful 
for bottle-fed children, who continually alternate between diarrh&a 
and constipation, and is also useful in cases of rickets to regulate the 
bowels. It should be added to each bottle of milk in the dose of 2 to 
4 grains (0.12-0.25). Phosphate of sodium in small doses is slightly 
laxative, and large doses are purgative. Bartholow believed phosphate 
of sodium to be the best remedy in hepatic cirrhosis and jaundice. 
To adults it should be given in the dose of 20 grains to 2 drachms 
(1.3-8.0) once, twice, or thrice a day according to the laxative effect 
desired. It is best given dissolved in a teacupful of hot water. 

Many cases of general wretchedness or headache due to an excess of 
uric acid in the blood are relieved by the acid phosphate of sodium or 
of calcium, since both substances cause disappearance of the acid 
from the blood, not by causing its elimination, but by causing its 
deposit in the tissues in the form of urates. The continued use of 
these so-called acid- phosphates is therefore ultimately harmful in 

gouty or rheumatic persons. 

The U. S. P. and B. P. also recognize a preparation called Sodii 

Phosphas Effervescens; dose 2 to 4 drachms (8.0-16.0). Sodii Phos- 

phas Exsiccatus (U. S.) is about twice the strength of the ordinary 

phosphate ; dose -I to 1 drachm (2.0-4.0). 

(For an explanation of the purgative action of most salines see 

article on Magnesium Sulphate.) 

A solution of sodium phosphate (Liquor Sodii Phosphatis Com- 

positus) has been introduced into the U. S. P. of 1900. As each 

fluidrachm contains one drachm of sodium phosphate, the dose is 

the same as that of the salt. 



382 DRUGS. 



PHOSPHORIC ACID. 



The pure acid is rarely employed in medicine, but when given 
is used in 2- to 8-minim (0.1-0.5) doses. In the form of dilute phos- 
phoric acid {Acidum Phosphoricum Dilution, U. S. and B. P.) it is 
widely employed in the dose of 20 minims to 1 drachm (1.3-4.0) as a 
tonic and gastric stimulant. It is not a food to the nervous system, 
does not resemble phosphorus in its physiological action, and is not 
to be employed in its place. It does good in nervous exhaustion simply 
by stimulating the stomach and thereby aiding that organ in the diges- 
tion of food. Phosphoric acid is also official in the B. P. as Acidum 
Phosphoricum Concentratum. 

PHOSPHORUS. 

Phosphorus, U. S. and B. P., is a non-metallic element, generally 
obtained from bones, and is very soluble in oils, less so in ether and 
alcohol. Its odor is characteristic and peculiar. When placed 
in a dark room after exposure to light it is luminous, and if exposed 
to the air will ignite. It should be kept under water in tightly- 
stoppered bottles. Very commonly it is contaminated by arsenic 
and sulphur. 

Physiological Action. — Phosphorus is found in large amount, com- 
paratively speaking, in the bones and in the nervous system, and is a 
stimulant to the growth of both. It acts, therefore, as a direct tonic 
to nervous tissue and is a producer of bone. Upon tissue-waste the 
drug acts as a depressant, thereby preserving the body, as it decreases 
the elimination of urea and diminishes the quantity of carbonic oxide 
exhaled. 

Upon the growth of bones phosphorus has a most remarkable 
influence, causing, when it is given to young animals, great increase 
in the size of these parts. The first change noted is an enlargement, 
which consists in a jelly-like mass containing little or no bone salts, 
and this is finally converted into a very hard material which may fill 
the entire canal in the centre of the bone. Kissel has stated that this 
does not occur, but his results must be doubted in view of the thorough 
studies of Wegner. 

Acute and Chronic Poisoning. — When phosphorus is taken in poi- 
sonous dose, often from the ends of matches, no symptoms may come 
on for eight or ten hours. At the end of that time the peculiar taste 
of phosphorus may be noted in the mouth, the breath is heavily laden 
with its odor, and burning pain in the oesophagus, stomach, and abdo- 
men becomes a pressing symptom. Vomiting and purging now assert 
themselves, and both the matters which are vomited and those which 
are passed from the bowels may be luminous in the dark, owing to the 
presence of phosphorus. The vomit at first consists of food, then 
mucus, then bile, and then perhaps blood. All the symptoms of a mild 
gastro-enteritis may develop, but it is to be noted that constipation of 



PHOSPHORUS. 



383 



an obstinate type may be present instead of purging. Very soon the 
liver increases in size, and gives rise to general hypochondriac pain and 
tenderness as well as local swelling. At the end of twenty-four hours, 
or perhaps after the second day, a cessation in the symptoms occurs, 
and, if the physician be not on his guard, this will lead him to a hope- 
ful prognosis, but in the course of a few hours jaundice begins in the 
conjunctiva and then extends over the entire body. With the onset 
of jaundice the vomiting and pain return with renewed vigor. The 
matters vomited have often the color of "coffee grounds," due to exuded 
and altered blood. The bowels are absolutely confined, or the few 
hard masses of fecal matter which are passed are white and clay-like 

Fig. 54. 

1 ^ '■ 



mm 







>mmm 






Showing the fat-granules produced in the liver in phosphorus poisoning. (Kast and Rumpler.) 

because of the absence of biliary coloring matter. There is no bile 
in the vomit in this stage, because the hepatic ducts have been closed 
by the inflammation which has been produced in the liver. Later, 
nervous symptoms ensue. Muscular twitchings, headache, vertigo, 
wild delirium, erotic convulsions, and finally unconsciousness and 
death, occur. Sometimes the convulsions occur just before dissolu- 
tion. Even if the patient survives the acute stage of the poisoning, he 
generally dies of the changes produced in his vital organs, which con- 
sist in widespread fatty degeneration. These fatty changes occur 



384 DRUGS. 

even in the acute form of the poisoning. Atrophy of the liver, destruc- 
tion of the gastric tubules, pancreatic involvement, and kidney degen- 
erations aid in producing the ultimately fatal results. 

During poisoning by phosphorus the urine is scanty and perhaps 
albuminous, and is peculiar because of the unusual substances 
which are found in it. The most unusual of these is sarcolactic acid, 
which results from breaking down of the muscular tissues. Leucin 
and tyrosin are also found, and tube-casts with fatty globules in them 
are seen. Free fat-globules may also occur. Bile acids and bile color- 
ing matter are found in large amount, and the urine is generally dark- 
colored for this reason. As phosphorus is eliminated in the urine as 
hypophosphoric acid, this substance is also present. 

The symptoms of phosphorus poisoning may so closely resemble 
those of acute yellow atrophy of the liver as to make a differential 
diagnosis impossible unless some evidence of the presence of phos- 
phorus is obtainable. 

In chronic poisoning by phosphorus, when, by the inhalation of its 
fumes, systemic changes occur, the most common lesion is necrosis of 
the lower jaw, which may be widespread or limited. It never occurs 
in those who have no solution of continuity in the teeth or gums, and 
for this reason it is necessary that the employes in match factories 
should have their teeth and gums constantly attended to. It has been 
said that pans containing turpentine when set around the work-room 
will protect the workmen, but this is certainly incorrect. 

Treatment of Acute Poisoning. — The antidote to phosphorus is 
generally taught to be the sulphate of copper, which will also act as an 
emetic if given in excess, but studies made by Thornton in my labo- 
ratory at the Jefferson Medical College prove that it is as dangerous 
a poison as the phosphorus. Peroxide of hydrogen and permanganate 
of potassium are probably the best antidotes. Oil of turpentine, in 
America, is not only valueless as an antidote, but harmful, for only 
old, ozonized French oil of turpentine is antidotal in its influence. 
As phosphorus is soluble in oils, we simply aid in its absorption if 
any such substances are given. 

Therapeutics. — Owing to its influence on the development of bone, 
phosphorus is very useful in rhachitis and osteomalacia. It is also 
useful in the sweats of general or nervous debility and in nervous ex- 
haustion, and in some cases of melancholia depending upon overwork. 
In the course of prolonged exhausting diseases, as typhoid fever or 
typhoid pneumonia, the drug is of service if the nervous system seems 
to be particularly affected, and in convalescence it is of service in aid- 
ing to build up the shattered forces of a patient. 

In the sequelae of acute and chronic alcoholism and in morphiomania 
it is of service. Phosphorus is also employed in sexual exhaustion 
or abuse. In boils and carbuncles and similar disorders phosphorus 
is very useful, particularly so in acne indurata. In pneumonia some 
physicians use minute doses with the belief that it aids in the produc- 



PHYSOSTIGMA. 385 

tion of resolution. Probably it does good in these cases by stimulating 
or supporting the nervous system. 

In the neuralgia from nerve-depression and in cerebral softening 
and meningitis of a chronic type phosphorus may be given with ad- 
vantage. 

The dose of phosphorus is jfa to -g- 1 -^ grain (0.0006-0.0012) in pill 
form (Pilulw Phosphori, B. P.) , but it may be gradually pushed to 
Yq- grain (0.003) if urgently needed. Phosphorated oil (Oleum Phos- 
phoratum, B. P.) and Spiritus Phosphori, are given in the dose of 1 
to 5 minims (0*05-0.30) . Elixir Phosphori is given in the dose of 15 
minims to 1 drachm (1.0-4.0). 

The beginning dose of phosphorus should not be above j-J-q grain 
(0.0006), for fear of some idiosyncrasy. 

PHYSOSTIGMA. 

Physostigma, U. S. (Physostigmatis Semina, B. P.), is a seed derived 
from Physostigma venenosum, a tree of West Africa, often called 
Calabar bean. It contains two alkaloids, eserine or physostigmine 
and calabarine. The former is the most important from a medical point 
of view. 

Physiological Action. — When a moderate dose of physostigma is 
given by the mouth it often produces some pain in the stomach and a 
sense of oppression and weakness. The pulse becomes slow, the respi- 
ration is depressed, and the pupils are contracted. Calabar bean in 
poisonous dose is a general paralyzant, but if the alkaloid calabarine 
be present in excess, it may be a convulsant. 

Nervous System. — On the spinal cord in poisonous dose this drug 
acts as a depressant poison, particularly affecting the sensory tracts. 
On the motor nerves it exerts no influence unless given in toxic doses, 
when it depresses their peripheral ends. The sensory nerves escape, but 
sometimes even they are involved. On the voluntary muscles the drug 
in these doses causes twitchings. In medicinal doses the drug is a stim- 
ulant to unstriped muscular fibre and acts as a mild nervous sedative. 

Circulation. — Calabar bean causes little circulatory change, but 
poisonous doses at first produce a rise of arterial pressure, due to a 
direct stimulation of the heart and of the muscular coats of the vessels. 
It slows the pulse by peripheral stimulation of the vagi. In medicinal 
dose its circulatory effect is not marked, but is depressant rather than 
stimulant. 

Respiration. — In moderate amount Calabar bean does not affect 
respiration, but in poisonous dose it produces death by paralysis of 
the respiratory centre. 

Pupil. — Physostigma causes myosis or contraction of the pupil by 
stimulation of the circular muscular fibres of the iris, and not by depres- 
sion of the sympathetic fibres, nor by stimulation of the oculomotor 
fibres, nor again by causing contraction of the bloodvessels of the iris. 
It decreases intraocular tension, produces temporarily an increase in the 

25 



386 DBUGS. 

power of accommodation for near objects, and then causes spasm of 
accommodation. The myosis usually develops in about eight to four- 
teen minutes after the drug is dropped into the eye, and reaches its 
maximum in thirty minutes, lasting for from six to eight hours. The 
partial influence may last, however, for four or five days. 

Alimentary Tract. — Physostigma is a stimulant to intestinal 
peristalsis, increasing the muscular activity in the walls of the gut 
and acting as a tonic to these fibres. 

Poisoning. — Poisonous doses of physostigma cause muscular trem- 
ors, followed by complete muscular relaxation. The pupils contract, 
the respirations become slow and irregular, and all reflex action fails. 
Vomiting or purging may or may not occur. 

Treatment of Poisoning. — This consists in the use of atropine, 
which is the physiological antidote; in the application of heat to the 
body, and the use of respiratory and cardiac stimulants, such as digi- 
talis, alcohol, or ammonia. 

Therapeutics. — Calabar bean has been employed in many affections, 
such as trismus neonatorum, tetanus, and other spasms, with only mod- 
erately good results. It is, however, of value in atony of the bladder 
and intestine and in catarrh of the bowels. Combined with nux 
vomica the author has used it with advantage in cases of gastric and 
intestinal dilatation. Some physicians think it of value in cases of 
tympanites, but in a limited use of it in certain severe cases of 
pneumonia with tympanites the writer has not found it of value. 

In bronchial asthma and emphysema it aids in expulsion of the 
mucus by its influence over the muscular fibres in the walls of the 
air-tubes. It is also useful in purgative pills to stimulate the mus- 
cular fibres of the intestine. (See Constipation.) 

In the eye,in the strength of 1 to 2 grains to the ounce (0.06-0. 12 : 30.0) 
of water, eserine is used in the treatment of corneal ulcerations, for 
the relief of glaucoma, and to diminish high intraocular tension. If, 
for any reason, atropine mydriasis is to be rapidly overcome, eserine 
may be used, but it is not so powerful a myotic as atropine is a 
mydriatic, and it requires larger amounts of the solution to produce 
contraction than it took of atropine to cause mydriasis. 

Administration. — Physostigma is used in the form of the extract 
(Extractum Physostigmatis, U. S. and B. P.) in the dose of -J- grain 
(0.008), which may be readily increased to J grain (0.015). 

The tincture (Tinctura Physostigmatis, U. S.) is given in the dose 
of 5 to 30 minims (0.3-2.0). 

Eserine is usually employed in the form of one of its salts. Phy- 
sostigmin(B Salicylas, U. S., and Physostigmina? Sulphas, U. S. and 
B. P., may be used in the dose of -^ grain (0.0008) three times 
a day. The sulphate is much more soluble, and is generally to be 
employed. The salicylate is largely used, nevertheless, by ophthal- 
mologists. Lamella? Physostigmina?, B. P., each contain 10 1 00 grain 
(0.00006) of physostigmine sulphate. The dose of both salts of eserine 
is y^o to -gV grain (0.0006-0.0008). 



PILOCARPUS. 387 



PICRIC ACID. 



Picric Acid, or Trinitrophenol, occurs in light-yellow scales or needles 
without odor, and is chiefly used in the arts as a dye. Its uses in 
medicine are limited. Recently it has been found exceedingly effica- 
cious in solution in the treatment of burns and scalds. This solution 
is made as follows: 

1$ — Acid, picric gr. lxxv (5.0). 

Alcohol fgiiss (75.0). 

Aquse destillatse Oij (960 c.c). — M. 

After the burn is cleansed of dirt and charred clothing, .strips of ster- 
ilized gauze are soaked in this solution and applied to the part. Over 
this is placed a pad of dry absorbent cotton which is fastened by a light 
bandage. The dressing rapidly dries, and may be left in place for 
several days. It is then moistened with the solution so as to soften it, 
is removed, and then a fresh dressing is applied for a week. All blisters 
should be pricked. This dressing relieves pain, prevents suppuration, 
hastens healing, and results in a smooth cicatrix. As this dressing 
stains the hands, the physician should use rubber gloves when 
applying it. 

PILOCARPUS. 

Pilocarpus, U. S. (Jaborandi Folia, B. P.), is derived from the 
South American tree, Pilocarpus selloanus or Pilocarpus jaborandi. 
It contains two alkaloids, known as pilocarpine and isopilocarpine. 
Jaborine is a combination of these alkaloids and a resinous substance. 
The alkaloid pilocarpine is non-crystallizable and occurs as a soft 
mass, but the salts of pilocarpine are crystallizable. 

Physiological Action. — When jaborandi is taken in medicinal dose 
by a healthy man, it causes a deep flushing of the face and neck, fol- 
lowed by the outbreak of a profuse sweat, which, though beginning 
in these regions, rapidly spreads over the entire body. Accompany- 
ing the sweat, salivation is often exceedingly profuse, so that saliva 
dribbles from the mouth. The sweat lasts from two to five hours. 
Nausea frequently comes on, and severe vomiting may appear 
in susceptible persons either during or after the sweating. Some 
individuals are singularly insusceptible to the diaphoretic influence 
of pilocarpus, and this is particularly so, according to Ringer, with 
children, who will often take as much as 60 grains (4.0) of the crude 
drug before they perspire. 1 

Nervous System. — Moderate doses given to men have no effect on 
this part of the body. 

Circulation. — In large doses there is no doubt that jaborandi acts 
as a cardiac depressant rather than a stimulant. The drug causes 
in the lower animals a slow pulse and decreased arterial pressure, in 
moderate quantities, the first change being due to an action on the 
inhibitory centres in the heart or on the peripheral vagi. (See Fig. 

1 The writer has reported a case (see Idiosyncrasy) in which a woman of thirty years received % 
grain of the muriate of pilocarpine hypodermically in half an hour without any effect. 



388 



DRUGS. 



55.) In man the drug does not slow the pulse, but quickens it very 
markedly, often as much as forty to fifty beats per minute. Although 
the pulse in animals is generally made stronger by its use, in man 
it is generally made weaker. 

Stomach. — Jaborandi sometimes produces nausea and vomiting by 
irritating the stomach and perhaps the vomiting centre. 

Temperature. — Jaborandi lowers bodily temperature to a con- 
siderable degree, probably by the dilatation of the peripheral capil- 
laries and the profuse sweat which it produces. This fall is sometimes 
preceded by a brief rise. 

Kidneys and Tissue-waste. — Upon the kidneys jaborandi acts 
very slightly or very strongly, according to the dose that is given. 
Large doses, which produce a profuse sweat, naturally decrease the 

Fig. 55. 



\i\(WW\q|WV 



II 



III 



IV 




Parts of a tracing showing the effect of pilocarpine in depressing blood-pressure, and the stimu- 
lant effect of atropine upon blood-pressure in the circulation of a dog. (After Schmiedeberg.) 
I. Shows the pulse-rate and blood-presure unaffected by drugs. II. Pilocarpine injected, which 
slows the pulse from 28 in ten seconds to 19 in ten seconds, and lowers the blood-pressure from 
126 to 96. III. Further depression and slowing; pressure, 70. IV. Atropine given, which raises 
blood-pressure to 145 and pulse-rate to 30. 



urinary secretion, but small ones undoubtedly increase it. Upon the 
tissue-changes in the body under pilocarpine no researches have been 
made, but it is an undoubted fact that in disease the excretion of urea 
is largely increased under the influence of this drug. 



PILOCARPUS. 389 

Eye. — Jaborandi contracts the pupil by stimulating the peripheral 
ends of the oculomotor nerve in the iris. 

Skin and Secretion. — The amount of sweat caused by the drug 
in man may equal as much as a pint, and it is generally first acid, ficm 
the secretions of the sebaceous glands, then neutral, and finally alka- 
line. The sweating is not primarily due to vasomotor palsy, but to 
stimulation of the ends of the nerves supplying the glands and of the 
sweat-glands themselves. The sweat usually lasts about two to five 
hours. Sometimes excessive salivary secretion supplants that of the 
skin. 

Pilocarpine increases the gastric, salivary, and lachrymal secretions, 
as well as that of the skin and kidneys. It also seems to have con- 
siderable influence over the secretion of milk. 

Therapeutics. — Jaborandi, or, better still, its alkaloid, pilocarpine, 
is of some value for the relief of dropsy of the renal type. In that 
due to cardiac disease it is generally too depressing, and the author 
knows of a case in which a fatal result speedily followed its use under 
these circumstances. It may be used to abort an attack or paroxysm 
of malarial fever, but because of its depressant influence should never 
be employed in asthenic fevers, such as typhoid fever. In pleurisy with 
effusion it has been used, but more efficient remedies are elaterium, or 
salines given in concentrated form and at the proper time of the day. 
(See Magnesium Sulphate and Dropsy.) Better than all these is 
thoracentesis. Spaulding and de Schweinitz have both recommended 
very highly the hypodermic use of pilocarpine in the dose of yj to 
Y 1 ^ grain* (0.005-0.006) a day for opacities of the vitreous humor of the 
eye. The fluid extract of jaborandi may be employed, but is apt to 
nauseate the patient. Diaphoresis should not be produced. Because 
of its myotic influence on the pupil pilocarpine is of very great value 
in the treatment of all conditions of the eye associated with increased 
intraocular pressure. It is so good a myotic as to be rapidly supplant- 
ing eserine for this purpose with some clinicians. The strength of pilo- 
carpine solution for this purpose is 1 to 4 grains (0.06-0.25) to the 
ounce (30.0). It should be dropped into the eye, 1 or 2 drops at a 
time, every hour until the patient is relieved. Pilocarpine is also use- 
ful as an ocular tonic to relieve eye-pain after excessive use of the eyes, 
in the strength of -^ grain (0.006) to the ounce (30.0). A few drops 
of this solution may be dropped into the eye three times a day. This 
solution should have a little boric acid (4 grains) added to it to prevent 
fungus growth. (See Asthenopia.) Clinical reports show that pilocar- 
pine in small doses is a good remedy in tobacco and alcoholic amblyopia. 

Mitkowski has tried pilocarpine in catarrhal jaundice of a persistent 
type with great benefit, in the hypodermic dose of J grain (0.01) every 
other day for three weeks. In uremic poisoning pilocarpine is theoreti- 
cally the most efficient and rapidly acting remedy that we have, and 
when used in Bright' 's disease it may be of value in several ways — first, 
by removing the strain on the kidneys; second, by eliminating the 
uraemic poison; and, third, by decreasing the inflammatory condition in 



390 DRUGS. 

the kidneys by lowering the blood-pressure, which it will be remem- 
bered, is the more constant effect of the drug in man. Care should 
always be exercised in the use of the drug lest cardiac depression ensue, 
and alcohol or strychnine may often be used with advantage to guard 
against this accident. The general consensus of opinion is that in 
the nephritis of middle years or advanced life with cardiac changes it is 
contraindicated. The author never uses it in chronic parenchymatous 
nephritis. In the ursemic convulsions of pregnancy pilocarpine, while 
theoretically useful, has been proved by experience to do more harm 
than good through its depressing influences, although the drug in small 
doses certainly increases renal activity. The hypodermic dose of pilo- 
carpine as a renal stimulant should be about ■£■$ to ■£$ grain (0.002- 
0.003). In some forms of p-ofuse sweating, such as come on at night 
in cases of general debility, pilocarpine, if given hypodermically or by 
the mouth about two hours before the sweat in the dose of -^ grain 
(0.003), is often useful even where atropine fails. The good effect is 
produced by stimulating the sweat-glands and so overcoming their 
atony. 

Da Costa, Salinger, and Barr have highly recommended the hypo- 
dermic injection of pilocarpine in erysipelas as a preventive and cura- 
tive measure in the early stages of this disease, and their reports are so 
encouraging as to warrant a careful trial of the method. The proper 
dose is \ grain (0.01) every three hours until free sweating ensues. 
After this is accomplished the doses may be repeated every four or six 
hours. The author would fear that such active treatment might seri- 
ously affect the strength of the patient unless stimulants were also used. 

In cases of obstinate aural vertigo a most efficient treatment is the 
hypodermic use of pilocarpine every few days in sufficient dose to pro- 
duce some salivation. The patient has to lie down or go to bed after 
the dose is given. 

Pilocarpine certainly has a decided effect in encouraging the growth 
of hair, and applied locally will often do good in partial baldness. If too 
much pilocarpine is used, it is apt to cause the development of small 
pustules about the hair-follicles. Bartholow recommended the following 
application for baldness: 

1^— Extract, pilocarpi fluid fgj (30.0). 

Tincturae cantharidis foss (16.0). 

Liniment, saponis f ojss (45.0).— M. 

The author has found the following prescription very efficacious in 
falling of the hair: 

ty — Extract, pilocarpi fluid f"5j (4.0). 

Tr. capsici . fgj (30.0). 

Tr. cantharidis f3ss (2.0). 

01. ricini f 5 j (4.0). 

Alcohol q. s. f 5iv (120.0).— M. 

S. — Apply with friction in spots to the scalp, night and morning. 

Antagonisms of Jaborandi. — Jaborandi is a physiological antidote 
to atropine and to agaricin. Four times the dose of pilocarpine must 



PIPEBAZINE. 391 

be used to counterbalance a dose of atropine. Vomiting produced by 
pilocarpus is to be antagonized by morphine. 

Untoward Effects. — Dimness of vision, vomiting, sudden collapse, 
swelling of the salivary glands and tonsils, hiccough and strangling 
are sometimes met with after using pilocarpus. Sometimes bloody 
leucorrhcea is seen. The vomiting can usually be prevented by full 
doses of chlorodyne. 

Prentiss has called attention to the fact that the continued use of 
pilocarpine may cause the hair to become coarse and dark. 

Administration. — The dose of jaborandi is 40 grains (2.6) used in 
the form of the powdered leaves in infusion. The fluid extract (Fluid- 
extractum Pilocarpi, U. S.; Extractum Jaborandi Liquidum, B. P.) 
should be used in the dose of 10 to 40 minims (0.60-2.6). Pilocar- 
pine is far superior to jaborandi,. in that it does not so often produce 
nausea and vomiting. It is used in the form of the hydrochloride 
(Pilocarpine Hydrochloridum, U. S.), in the dose of from J to \ grain 
(0.008-0.03) hypodermically, or J to \ grain (0.015-0.03) by the mouth. 

The additional preparations of the B. P. are — the tincture (Tinc- 
tura Jaborandi), dose \ to h fluidounce (8.0-16.0); and the nitrate of 
pilocarpine (Pilocarpine? Nitras), \ to \ grain (0.008-0.03). 

PIPERAZINE. 

Piperazinum is a substance, the chemical formula of which is C 4 H 10 N 2 , 
which has been recently introduced into medicine for the treating of 
the uric-acid diathesis. It is not stable, and when exposed to the air 
attracts water and carbonic acid ; so it must be kept in tightly-stoppered 
bottles. Aqueous solutions are decidedly alkaline, but do not have any 
distinct taste. 

Piperazine is peculiar in its power to dissolve uric acid, dissolving 
twelve times as much as will carbonate of lithium, while it is also 
entirely soluble in water, which lithium is not. When taken into the 
body the drug is partly oxidized and partly eliminated unchanged. 
Theoretically, piperazine, when taken into the body, forms with uric 
acid a urate of piperazine, which is soluble and readily eliminated. 
Experiments to determine this point have been made with very satis- 
factory results, and repeated clinical observation has shown that the 
administration of the drug causes an increase in the amount of urea 
in the urine with a decrease in the uric acid, indicating that under its 
influence oxidation is more complete. 

Therapeutics. — Piperazine is used for the purpose of preventing the 
formation of renal and vesical calculi in the uric-acid diathesis, and 
also in cases where the excess of uric acid in the urine tends to pro- 
duce irritation of the bladder. Similarly, its action has been found 
of value in treating vesical irritation due to this cause by washing out 
the bladder with a solution of piperazine of the strength of 1 per cent. 
Piperazine has also been injected into uric-acid deposits about the 



392 DRUGS. 

body or applied to the broken-down surfaces of these deposits in 1 
per cent, solution, but the author has not been favorably impressed 
with this method, and would advise against its use — first, because it 
does little if any good, and, second, because the method is painful 
and apt to cause sloughs by interfering with nutrition of the skin, 
which is already lacking in health. 

The dose of piperazine is 15 grains (1.0) in twenty-four hours. It 
is best given by dissolving this amount of the drug in 1 pint (480 c.c.) 
of water, and directing the patient to take a wineglassful of the solu- 
tion frequently through the day. Owing to the effect upon the drug 
of exposure to air, it cannot be given in pill or powder, and should 
be freshly mixed each day. The writer has failed to obtain any results 
from the use of this drug in his practice. 

Stewart has noted, as untoward effects of full doses of piperazine 
tremors, hallucinations, and clonic spasms. 

Lycetol is a substance closely allied to piperazine, and is used in 
medicine for the same purposes. Dissolved in water it has a taste 
somewhat like lemonade. Unlike piperazine, it is not hygroscopic and 
will keep indefinitely. The dose of lycetol is 15 to 30 grains (1.0-2.0) 
a day, well diluted with water, to which a little sugar may be added to 
improve the taste. Usually it is best to give the drug in carbonated 
water, and to begin with small doses, which are to be gradually in- 
creased in size. 

PISCIDIA ERYTHRINA. 

Piscidia Erythrina is a drug which is stated to possess marked nar- 
cotic and pain-relieving properties. It is sometimes called Jamaica 
dogwood. Its powers as a soporific and analgesic do not compare 
with those of opium, but it is stated to be devoid of the unpleasant 
after-effects of the latter drug. Further studies concerning its effects 
on the animal economy are needed. According to Dr. Isaac Ott and 
Dr. Nagle, the drug has little or no effect on the motor and sensory 
nerves, and its dominant effect on the circulation is to increase arterial 
pressure through stimulation of the vasomotor system. The indica- 
tions which have been met best by piscidia are dysmenorrhea due to 
irregular flow and spasm of the uterine cervix and fundus, to allay 
nervous irritability, and to relieve pain or insomnia due to pain. 

Administration. — The dose of the fluid extract of piscidia erythrina 
is £ to 2 drachms (2.0-8.0); of the solid extract, 2 to 10 grains (0,12- 
0.60). The alkaloid piscidine is not known to represent all the prop- 
erties of the drug, and is not used in medicine. 

PITCH. 

Fix is a resinous exudation derived from several species of pines, 
firs, and spruces, and is, in one of its forms, obtained by the evapora- 
tion of wood-tar. It is used for various purposes, according to its deri- 



PODOPHYLLUM. 393 

vation. Burgundy Pitch (Pix Burgundica, B. P.) is derived from 
Norway spruce, or Abies (Picea, B. P.) excelsa, a plant of Europe 
and Asia. It softens and melts at the temperature of the body and is 
useful for plasters. In muscular rheumatism and in chronic bronchitis 
pitch is a mild and fairly useful local remedy for external use. In 
the form of the plaster (Emplastrum Picis, B. P.), and in the form 
of warming plaster (Emplastrum Picis Cantharidatum) , it is employed 
for the relief of deep-seated sprains and bruises, and acts as a mild 
counterirritant, which may blister a tend r skin. Canada Pitch (Pix 
Canadensis) is obtained from the hemlock spruce of Canada and 
the United States, and is used for the same purposes as Burgundy 
pitch. The Canada-pitch plaster (Emplastrum Picis Canadensis) 
is employed for the same conditions as the plaster of Burgundy 
pitch. 

PODOPHYLLUM. 

Podophyllum, U. S., May Apple or Mandrake, is the rhizome and 
small roots of Podophyllum peltatum, a plant of the United States and 
Canada. Podophyllum contains a resin, podophyllin. 

Therapeutics. — Podophyllum is the slowest-acting purge official in 
the Pharmacopoeia. In small doses it is laxative, but is purgative and 
almost drastic in larger amounts. In overdose it may produce gastro- 
enteritis. The drug particularly excites the flow of bile, and is used as 
a cholagogue. It is best given when the stools are dark in color, calomel 
being indicated when they are light. The author has found the follow- 
ing prescription useful in cases of intestinal flatulence and indigestion 
with constipation: 

R— Podophyllin gr. v. (0.30). 

Euonymin gr. v. (0.30). 

Leptandrin gr. v. (0.30). 

Ext. chiratae gr. xlv. (3.0). 

Creasotse gr. x. (0.60). — M. 

Ft. in pil. No. xx. 

In children one or two months old who have hard, stony stools podo- 
phyllin is a good remedy. The dose should be given by dissolving a 
grain of the resin in a drachm of alcohol and using 2 drops or more 
of this on sugar once or twice a day. In children who suffer from summer 
diarrhea, in which the passages consist almost entirely of water, which 
have a peculiar musty smell or a mouse odor, podophyllin in the dose 
of g^ to -5^ grain (0.001-0.0012), repeated every few hours, is of 
service, seeming to control the passages and make them normal. This 
treatment will often succeed when all else fails. This statement is 
also true in regard to the chronic diarrhoeas of adults, though the drug 
should be given in somewhat larger amounts in such cases. Podo- 
phyllin will also check vomiting in these doses in some instances, pro- 
vided that the stomach is depressed and the liver is torpid. It should 



394 DRUGS. 

not be employed if the vomiting is due to irritation or inflammation 
of the stomach. 

Administration. — Podophyllum is used in the form of the extract 
(Extraction Podophylli), dose 1 to 5 grains (0.06-0.30) ; the fluid 
extract {Fluidextr actum Podophylli, U. S.), dose 2 to 20 drops 
(0.12^1.3); and, more commonly than all, as the Resina Podophylli, 
U.|S. and B. P., or podophyllin, which is the best preparation. The 
dose of this preparation is from fa to fa grain (0.003-0.006) as a 
feeble laxative, and from fa to \ grain (0.006-0.03) as a purge. 
The tincture of resin (Tinctura Podophylli, B. P.) is given in the 
dose of 5 to 15 minims (0.3-1.0). 

POMEGRANATE. 

Although Granatum, U. S. (Granati cortex, B P.), is official, it is 
almost never used in America in its crude form. It contains an alka- 
loid known as pelletierine, this alkaloid being a colorless liquid, soluble 
in 20 parts of water and readily miscible with ether, chloroform, and 
alcohol. When acids are added to it it forms crystalline salts, of which 
four are used — namely, the tannate, the sulphate, the hydrobromate, 
and the hydrochloride. The first is most commonly employed, and 
is a yellowish powder possessing an astringent taste. It is soluble 
in 700 parts of water and 80 of alcohol. Its physiological action needs 
further investigation, but the drug in poisonous amounts paralyzes 
the peripheral ends of the motor nerves in a manner closely resembling 
the action of curare. Sensibility is preserved The loss of power is 
chiefly manifested in the lower limbs, in which at first there may be 
cramps. There may also be nausea and vomiting. 

Therapeutics. — Originally, pomegranate was largely used in the form 
of the rind of the fruit in decoction as a vegetable astringent, but 
this practice has ceased because of its disagreeable taste and effect upon 
the stomach. The ailments which were supposed to indicate its 
employment were serous diarrhoea and profuse sweats. In some trop- 
ical countries the bark of the root is used as a vermifuge, and it is very 
efficient in removing the tape-worm. It is said that the bark of the 
root of the wild shrub is much more efficacious than that of the cul- 
tivated and more handsome plant. To be effective the dose of the 
decoction of the bark must be large. The drug is prepared by soak- 
ing 2 ounces (60.0) of the bark in 2 pints (960) of water for twenty- 
four hou^s and then boiling down to a pint (480). A wineglassful 
(30.0) of this is the dose which is generally given, and it may be repeated 
every hour until the whole amount is taken. The objection to this 
line of treatment is that it is unnecessarily severe, often purging and 
vomiting the patient excessively. The nausea produced is often great. 
Should purging fail to occur, it is necessary to give castor oil or other 
purge to dislodge the worm, and it is always necessary to starve the 
patient for twelve hours before the remedy is tried. 



POTASSIUM CITRATE. 395 

The dose of pelletierine is 3 to 5 grains (0.20-0.30), and the tannate 
(Pelletierinoe tannas, U. S.) is the salt usually employed. Practically, 
the only pelletierine used is that of Tanret, and his preparation is 
a syrupy solution in each bottle of which is one dose of the drug. 

As large doses as 20 grains (1.3) of pelletierine have been used, 
but as serious paralytic symptoms have ensued after the ingestion of 
5 grains by a susceptible woman, not more than this amount should 
be given. When pelletierine is used, it should always be followed in 
two hours by a purge. Those who have used it most place great 
reliance on it. The fluid extract (Fluidextr actum Granati, U. S.) is 
given in the dose of 20 to 30 minims (1.3-2.0). The B. P. con- 
tains one official preparation of pomegranate — namely, the Decoctum 
Granati Corticis, the dose of which is 1 to 2 fluidounces (30.0-60.0). 

POTASSIUM BICARBONATE. 

This salt (Potassii Bicarbonas, U. S. and B. P.) is used for the 
same purposes as the citrate and acetate of potassium, and, as it is 
much less agreeable in taste, should not be employed when they can 
be obtained. From the bicarbonate of potassium are made several 
very useful preparations: the liquor potassii citratis, by adding 120 
grains (8.0) to 90 grains (6.0) of citric acid and 10 ounces (300.0) of 
water; the neutral mixture, by adding to 1 pint (480.0) of lemon-juice 
enough of the potassium salt to neutralize it. The dose of potassii 
bicarbonas is 5 to 40 grains (0.3-2.6), or even as much as 2 drachms 
(8.0) may be given if well diluted with water. 

POTASSIUM BROMIDE. 

(See Bromide of Potassium.) 

POTASSIUM CARBONATE. 

Carbonate of Potassium (Potassii Carbonas, U. S. and B. P.). Tj^is 
salt is never used in medicine, except to prepare other salts, as it is dis- 
agreeable to the taste and is an irritant. (See Potassium Citrate.) 

POTASSIUM CITRATE. 

Citrate of Potassium (Potassii Citras, U. S. and B. P.) is a white, 
granular, deliquescent salt, almost neutral in reaction and very solu- 
ble in water. It is by far the most agreeable of all the salts of potas- 
sium to the taste. In the early stages of bronchitis it is of the greatest 
value when combined with ipecac (see Bronchitis), and it is also use- 
ful as an alkaline diuretic. In bronchitis the dose should be 20 grains 
(1.3) every four hours, and in urinary incontinence due to acid and 
concentrated urine the dose should be equally large. 



396 DRUGS. 

Under the name of neutral mixture (Mistura Potassii Citratis), 
made by adding to 1 pint (480 c.c.) of lemon-juice enough bicarbonate 
of potassium to neutralize it, we have a useful febrifuge drink in fevers, 
particularly those of childhood. The dose is J to 1 ounce (16.0-30.0) 
every few hours. 

Liquor Potassii Citratis, U. S., is made in the same manner as is 
the neutral mixture, except that citric acid is substituted for the lemon- 
juice (citric acid 6 grm., potassium bicarbonate 8 grm., and water 
ICO c.c). 

The neutral mixture is the better preparation of the two, but more 
expensive. A very refreshing and agreeable way of prescribing this 
drug is in the form of "effervescing draught," made by mixing two 
solutions which are prepared as follows: 1. Lemon-juice and water, 
equal parts, enough to make 4 ounces (120 c.c). 2. Bicarbonate of 
potassium 1 drachm (4.0) and water 3 ounces (90.0). These solutions 
are to be mixed in the quantities desired, and taken while effervescing. 
If lemon- juice is not at hand, a solution of citric acid of the strength 
of 2 drachms (8.0) to 4 ounces (120.0) of water should be employed 
in its stead. 

Under the name of Potassii Citras EJfervescens the U. S. P. of 
1900 calls for an official powder possessing the advantages of the 
mixture just named. 

POTASSIUM IODIDE. 

(See Iodide of Potassium.) 

PROTARGOL. 

Protargol is a new silver preparation containing 8.3 per cent, of 
silver, and occurs as a yellowish powder readily dissolved in cold and 
hot water, forming a clear solution. It is employed in gonorrhea and 
in gonorrheal conjunctivitis because it is destructive to the gonococcus. 
(See Conjunctivitis.) It is not precipitated on contact with albumin 
of alkalies, nor by dilute hydrochloric acid. It therefore has distinct 
advantages over nitrate of silver. Al to 5 per cent, solution of pro- 
targol is the strength ordinarily used in the treatment of gonorrhoea, 
and these solutions may also be employed in the eye. (See Conjunc- 
tivitis.) If used on a camePs-hair brush or swab, the solution may be as 
strong as 5 per cent. ; but if the drug is used as a collyrium its strength 
should not exceed 1 : 400 or 1 : 200. 



PRUNUS VIRGINIANA. 

Prunus Virginiana, U. S., and Pruni Virginian® Cortex, B. P. — 
Wild Cherry, as it is incorrectly called — is the bark of Prunus sero- 
tina, a large tree of the United States and Canada. It contains a 
substance, known as amygdalin, which when it comes in contact with 



QUASSIA. 397 

water forms hydrocyanic acid through the action of another substance, 
known as emulsin. 

Therapeutics. — Wild-cherry bark is largely used as a domestic tonic, 
and in the form of a syrup as a vehicle for cough mixtures. 

It has been supposed that the hydrocyanic acid present allays the 
cough, but this is doubtful, as the acid is fleeting in its effect and 
is present in very small quantity. 

Administration. — As a tonic prunus virginiana is used in the form 
of the infusion (Infusum Pruni Virginianoe, U. S.), dose \ to 1 
ounce (16.0-30.0), and the fluid extract (Fluidextractum Pruni 
Virginianoe, U. S.), dose 30 minims to 1 drachm (2.0-4.0). The 
syrup (Syrupus Pruni Virginiana?, U. S. and B. P.) is given in the 
dose of 1 to 4 drachms (4.0-16.0). The B. P. also contains a tinc- 
ture (Tinctura Pruni Virginiana?), given in the dose of 1 to 2 
drachms (4.0-8.0). 

PYOKTANIN. 

(See Methyl Blue.) 



PYROGALLOL. 

Pyrogallol, U. S., sometimes called Pyrogallic Acid, is a triatomic 
phenol obtained by dry distillation of gallic acid, and should be kept 
in dark, well-stoppered bottles. It occurs in light white scales or 
crystals, has no odor, but a bitter taste. If exposed to the light, it 
becomes dark. It is soluble in 2\ parts of water, and readily so in ether 
and alcohol. 

Therapeutics. — Pyrogallol is used in parasitic skin diseases, irv 
ointment, in the strength of 30 to 100 grains (2.0-6.6) to the ounce 
(30.0). The stronger ointments exercise a mild caustic effect. It 
may be employed in place of chrysarobin in psoriasis. It stains the 
skin a deep brown. 

QUASSIA. 

Quassia, U. S. (Quassia? Lignum, B. P.), is the wood of Picrasma 
excelsa, a large tree of Jamaica and other islands of the West Indian 
group. It contains an active principle, named quassin, which is in- 
tensely bitter and an irritant to mucous membranes. 

Quassia is a simple bitter tonic which has been used very largely in 
domestic medicine and by the medical profession. It is very efficient 
as a tonic, is supposed to be particularly useful in the anorexia follow- 
ing malarial fevers, and has even been thought to possess antiperiodic 
power. In simple dyspepsia with eructations after meals, due to gastric 
inactivity, it is very serviceable. 

In the treatment of seat-worms (Oxyuris vermicularis) , or thread- 
worms, as they are often called, injections of the infusion of quassia 
are the most efficacious and useful remedial measures we possess, and 



398 DRUGS. 

yet are harmless to the patient. The bowel should be well washed 
out with soap and water, and J pint to 1 pint of an infusion, made 
by adding 1 to 2 ounces (30.0-60.0) of quassia chips to a pint (480) 
of water, should be injected and retained for some minutes. A few such 
injections will invariably kill the parasites, provided the bowel is first 
well washed out with soap and water and enough fluid is injected to 
reach high up into the rectum. 

Administration. — The tincture (Tinctura Quassias, U. S. and B. P.) 
is given in the dose of J to 1 drachm (2.0-4.0), the fluid extract 
(Fluidextractum Quassias, U. S.) J drachm (2.0), and the solid extract 
Extractum Quassias, U. S.) 1 to 3 grains (0.06-0.2). The infusion 
(Infusum Quassias, B. P.) is given in the dose of \ to 2 ounces 
(16.0-60.0), and is made by macerating 1 drachm (4.0) of quassia 
with 10 ounces (300.0) of water, and allowing it to stand twenty- 
four hours or more. 

Liquor Quassias Concentratus is official in the B. P. Its dose is 1 
drachm (4.0). 

QUERCUS. 

Quercus, U. S., or White Oak, in infusion made either from the 
crude drug 1 ounce (30.0) to the pint (4S0 c.c), or by adding the fluid 
extract (Fluidextractum Querci, U. S.) to water, is used as an 
astringent injection in gonorrhoea and vaginitis in women, where a 
large amount of fluid is necessarily employed. It is also used in 
prolapse of the rectum, in hemorrhoids, in leucorrhasa, and as a gargle 
in sore throat. It stains the clothing very slightly. 

Quercus Tinctoria is equally efficient, but is seldom used because 
it stains the clothing. In the form of the powdered bark it is often 
used as an astringent poultice to freely running sores, to check the 
discharge. 

RESIN, or ROSIN. 

Koolna, 0. S. and B. P., is Resin or Rosin, the mass left after the 
distillation of turpentine, and enters largely into plasters, cerates, and 
similar preparations. Its fumes when it is burnt are said to be of 
value when inhaled in cases of chronic bronchitis. Ceratum Resiim, 
U. S., is used in chilblains and superficial scalds. Ceratum Resinw 
Compositum, U. S., popularly known as Deshler's Salve, is used as a 
stimulating application. Unguentum Resince is a B. P. preparation 
used for the same purposes as the cerate. 

RESORGINOL. 

Resorcinol, U. S. (metadioxy benzol), is the raefa-com pound of the 
group of which hydrochinone is the para- and pyrocatechin the ortho-, 
and occurs in clear crystals of a slightly reddish hue. It is quite soluble 
in water, alcohol, and ether. 



RESORCINOL. 399 

Physiological Action. — Resorcinol is an irritant to mucous mem- 
branes, and when taken internally in poisonous doses causes deafness, 
giddiness, salivation, profuse sweat, unconsciousness, and clonic con- 
vulsions. The heart of the dog under its influence is at first slowed 
by vagal stimulation, and then becomes very rapid from vagal palsy. 

Therapeutics. — Resorcinol has been found of service as a remedy for 
whooping-cough, given in the dose of 10 minims (0.60) of a 2 per cent, 
solution or used in a spray of the same strength, the latter being the 
better method of using the drug. 

Resorcinol has also been employed in a spray in 2 per cent, solution 
in hay fever with remarkably good effects. It has been used as an 
antipyretic, but is not serviceable and has little power over fevers. 

The chief use of resorcinol is in skin affections of a subacute or 
chronic character, such as eczema with much induration, and in 
psoriasis. In these states an ointment of the following character, 
well applied, is of service: 

R— Resorcinol 3J (4.0). 

Zinci oxidi ^j (4.0). 

Ung. aquae rosse 5 x (40.0). — M. 

S. — Apply to the part affected twice a day. 
After mixing the ointment heat it until the resorcinol crystals melt, to prevent 
any irritation of the skin. 

Resorcinol is also of service in weak solution in allaying itching of 
the skin due to erythematous eczema. For this purpose it should be 
used in watery solutions of about 10 or 15 grains to the ounce, and a 
little salt added to aid in its absorption by the skin. This should be 
dabbed, not rubbed, on the part: 

R— Resorcinol gr. xv (1.0). 

Glycerin T^x (0.60). 

Liquor calcis fgj (30.0).— M. 

In the slowly spreading epithelioma of the face the following plaster, 
recommended by Hartzell, is useful: 

R — Resorcinol gr. lxxij (5.0). 

Cerse flav. et pulv. resinae gjss (6.0). 

01. Olivse q. s.— M. 

Another valuable use of resorcinol is in the treatment of seborrhea 
capitis of the dry, scaly type: 

R— Resorcinol 3J (4.0). 

01. ricini r^xxx (2.0). 

Alcohol f|ij (60.0). 

Spt. myrciae q. s. f|iv (120.0).— M. 

S. — Use as a lotion to the scalp, after washing with castile soap and water, 
once a day. 

Within the last few years resorcinol has been employed with good 
results in the treatment of gastric ulcer in the dose of 2 to 4 grains 



400 DRUGS. 

(0.12-0.25) before each meal in pill or capsule. It is supposed to act 
by reason of its analgesic, antiseptic, and haemostatic power. 

RHIGOLENE. 

Rhigolene is a product of petroleum obtained by repeated redistillation 
until the liquid resulting from this process boils at 64.4° F. It evap- 
orates more rapidly than any other known liquid, except cymogene, 
which boils at 32° F., and is used in a spray for the production of 
localized numbness or freezing before minor painful operations, such 
as the use of the actual cautery. 

RHUBARB. 

Rheum, U. S. (Rhei Radix, B. P.), is the root of several species of 
Rheum, a plant of Thibet, but which is cultivated in America and 
elsewhere. It is also derived from China, and this variety is known as 
Chinese rhubarb. Several alkaloids are contained in it, all of which 
are unimportant and never used alone, except chrysophanic acid. 

Physiological Action. — According to the studies of Prevost and 
Binet, rhubarb acts inconstantly upon the flow of bile, sometimes 
increasing it, sometimes having no effect; but, on the other hand, 
according to those of Rutherford and Vignal, it never fails to stimu- 
late biliary secretion. Owing to the astringent properties possessed 
by rhubarb, it does not purge excessively, and improves the appetite, 
digestion, and intestinal tone. Its constant use produces chronic con- 
stipation. 

Therapeutics. — Whenever it is desired simply to unload the bowels 
without affecting the general system rhubarb may be employed. In 
children a state is very commonly seen in which constipation is replaced 
by diarrhoea if any ordinary laxative is employed, and in these instances 
rhubarb is the best remedy, as it is astringent and prevents any after- 
effects other than those directly produced by the dose. In the summer 
diarrhwa of children, when the stools are green, rhubarb is often used 
to empty the bowels of fermentative products before direct treatment 
is instituted. 

Rhubarb, because of its chrysophan, may stain alkaline urine car- 
mine or acid urine yellow. 

Administration. — The preparations of rhubarb are unnecessarily 
numerous. Rhubarb itself may be given in the dose of 20 grains 
(1.3) in powder, and small pieces of the root are habitually chewed 
by some persons for the relief of constipation. Extr actum Rhei, 
U. S. and B. P., is given in the dose of 5 to 10 grains (0.30-0.60) 
in pills. Pilula? Rhei, U. S., of which each pill contains 3 grains 
(0.20) of rhubarb, is given in the dose of one to three pills; and 
Pilula Rhei Compositoe, U. S., and Cornposita, B. P., which con- 
tain 2 grains (0.12) of rhubarb and lj (0.09) of aloes, are given in 



BOCHELLE SALT. 401 

the same dose. Pulvis Rhei Compositus, U. S. and B. P., contains 
rhubarb, magnesia, and ginger, and is given in the dose of 20 to 40 
grains (1.3-2.6); Fluidextr actum Rhei, U. S., is given in the dose of 
20 to 30 minims (1.3-2.0). Syrupus Rhei, U. S. and B. P., is given 
in the dose of 1 drachm (4.0) to a babe, and 4 drachms (16.0) to an 
adult, although rarely used for older persons. Syrupus Rhei Aro- 
maticus, U. S., is given in the same dose and to the same class of 
cases. Tinctura Rhei, ll. S., is used in the dose of \ to 2 drachms 
(2.0-4.0), Tinctura Rhei Aromatica, U. S., Tinctura Rhei Composita, 
B. P., is used in the dose of \ to 1 drachm (2.0-4.0), and Tinctura 
Rhei Dulcis, U. S., 2 to 3 drachms (8.0-12.0). The aromatic syrup 
is commonly employed for children, and the compound pills for adults. 
Infusum Rhei, B. P., is given in the dose of 1 to 2 ounces (30.0-60.0), 
and Mistura Rhei et Soda?, U. S., in the dose of 2 drachms to 3 ounces 
(8.0-90.0). 

Liquor Rhei Concentratus is official in the B. P. Its dose is 1 drachm 
(4.0). 

RHUS AROMATICA. 

Sweet Sumac is unofficial, but has been so largely used of late that 
it deserves notice. In hematuria, menorrhagia, diabetes insipidus, 
and in urinary incontinence in children depending upon vesical atony 
it has been highly praised. In the latter affection a sufficient amount 
of experience has been acquired to show that it really is of benefit. 
Rhus aromatica should be used in the form of the fluid extract, derived 
from the bark of the roots according to the general directions in the 
Pharmacopoeia for making fluid extracts. The dose as a remedy for 
urinary incontinence is 15 minims (1.0) of this preparation. Adults 
may take from 15 to 60 minims (1.0-4.0). The drug is best given 
with glycerin and water. 

RHUS GLABRA. 

Rhus Glabra, U. S., Smooth Sumac, is the fruit of Rhus glabra, 
and contains tannic and malic acids as its chief constituents of medi- 
cinal value. In the fluid extract {Fluidextr actum Rhois Glabrae, U. S.) 
we have an official preparation which is very efficient as a gargle for 
sore throat when diluted with glycerin and water or prepared accord- 
ing to the formula given under Chlorate of Potassium. 

ROCHELLE SALT. 

Potassii et Sodii Tartras, U. S. (Soda Tartarata, B. P.), is largely 
used as a saline cathartic in the dose of J ounce (16.0), and is 
preferred by many patients to Epsom salt because its taste is not 
so disagreeable. It is, however, more irritating. Rochelle salt is 
the purgative constituent of Seidlitz powder. 

26 



402 DRUGS. 

ROSA GALLIGA. 

Rosa Gallica, U. S. (Rosoe Gallicce Petala, B. P.), Red Rose, con- 
tains gallic and tannic acids, and is astringent. From it are pre- 
pared the Fluidextractum Rosa?, U. S., dose 5 drops to 2 drachms 
(0.30-8.0), used to flavor other extracts, and the Confectio Rosa?, 
U. S., and Confectio Rosoe Gallicce, B. P., which are used as bases for 
pills. Mel Rosoe, U. S., or honey of rose, is employed as a local 
application or as a vehicle for gargles, and the Syrupus Rosoe, U. S. 
and B. P., dose 1 to 2 drachms (4.0-8.0), as a flavoring substance. 
The acid infusion (Infusum Rosx Acidum, B. P.) is given in the dose 
of 1 to 2 ounces (30.0-60.0). 

Aqua Rosoe, U. S. and B. P., is used as a diluent or solvent for 
preparations, such as astringents, which are to be employed locally, 
as in injections for gonorrhoea. It may also be used internally for 
these purposes. Unguentum Aqua" Rosa?, U. S. and B. P., is "cold 
cream," and is largely used as an emollient application to small 
burns, sores, cuts, scratches and chapped hands and lips. It is much 
improved if a little glycerin and benzoic acid are added to keep it 
sweet in warm weather. 



RUBUS ID^IUS, or RASPBERRY. 

Rubus Idams, or Raspberry, is used for the preparation of a syrup 
(Syrupus Rubi Idai), which is employed very largely as an elegant 
vehicle or flavoring mixture. The leaves are often used in domestic 
medicine in a decoction or infusion for the cure of diarrhwa when an 
astringent is needed. 

RUE. 

Ruta graveolens is the source from which is derived the Oil of Rue. 

Physiological Action. — Locally applied, rue is an irritant, producing 
vesication, and if taken internally in large amount gastro-enteritis, 
which may be very severe. It is eliminated by the lungs, kidneys, 
and skin, and its odor is easily recognized in all these secretions. If the 
dose be poisonous, vomiting, great pain in the belly, and epileptiform 
convulsions come on, but death has rarely occurred. 

Therapeutics. — Rue has been used as an abortifacient, but with 
great danger to the mother. Its action is most uncertain even when 
poisonous doses are employed. It has been given in colic as a 
carminative, and seems to be valuable in atonic menorrhagia and 
metrorrhagia. 

Oil of rue has been employed for the removal of lumbricoid or rounds 
worms, but ought not to be so used. The dose of the oil is 3 to 6 minims 
(0.20-0.40), best given in capsule. 



SALIC YLIC A OID. 403 



SACCHARIN. 



Saccharin (Benzo-sulpkanidum, U. S. ; Glusidum, B. P.) is a com- 
pound first prepared by Fahlberg, under the direction of Professor 
Remsen, of Johns Hopkins University. It is a remarkably sweet 
substance, two hundred and twenty times stronger than sugar in 
sweetening power and is a white crystalline powder which is almost 
odorless. It is used largely to sweeten glucose and in confections. 
Saccharin escapes from the body unchanged, and is used in place 
of sugar to sweeten coffee, food, or medicine in cases of diabetes and 

% ont 

The dose is indefinite, but it is to be noted that a very few grains 

will sweeten a large bulk of material. As 1 grain (0.06) is equiva- 
lent to about 1 teaspoonful (4.0) of sugar, less than 1 grain is the 
quantity usually given. It is commonly sold in small tablets contain- 
ing half a grain each (0.03). 

Physiological Action. — Upon the circulation and similar vital func- 
tions saccharin has no effect, but Plugge has proved it to retard the 
action of all the digestive ferments, and to be in consequence harmful 
to diabetics whose digestion is impaired. 

SALICIN. 

Salicin (Salicinum, U. S. and B. P.) is a glucoside obtained 
from several species of Salix and Populus. In other words, it is 
obtained from willow-bark. It is crystalline, without odor, and quite 
bitter, and is soluble in 28 parts of water and 30 of alcohol. Salicin 
is highly thought of by many practitioners as a substitute for salicylic 
acid in the treatment of acute articular and muscular rheumatism. 
It has also been largely used in the treatment of influenza. The dose 
is from 5 to 40 grains (0.30-2.6) every four hours, and it is best given 
in capsule or cachet, and washed down with a draught of water or milk 
after food has been taken. 

SALICYLIC ACID. 

Salicylic Acid (Acidum Salicylicum, U. S. and B. P.) occurs in 
fine white crystals or in fine white powder. It has a sweet yet acrid 
taste, and is derived from carbolic acid by treating it with caustic 
soda and carbonic acid at a moderate heat. Sometimes it is derived 
from plants in which it exists in combination, although the artificial 
acid is chiefly used. If the crystals are pinkish in hue, the acid should 
not be used, as it is probably impure. It is soluble in 500 parts of 
water and 4 parts of alcohol. 



404 DRUGS. 

Physiological Action. — On mucous membranes salicylic acid acts 
as an irritant. (See Poisoning.) 

Nervous System. — Upon the nervous system salicylic acid exerts 
a moderate influence when given in medicinal doses, and causes 
buzzing in the ears and decrease of the reflexes. In poisonous doses 
epileptiform convulsions are produced by an action on the brain. 

Circulation. — Upon the circulation the effects of salicylic acid 
are not very marked in medicinal dose. It undoubtedly has a depress- 
ant rather than a stimulant effect, but the depression is very slight. 
It is sufficient, however, to make the use of the drug in cases of feeble 
circulation worthy of thought and care. 

Respiration. — Salicylic acid feebly stimulates the pulmonary vagi 
and respiratory centre, but if the dose be poisonous death is due to 
respiratory failure. Medicinally it does not affect this function, 

Temperature. — The effect of salicylic acid on temperature has 
been studied by the author with a good deal of care. The drug acts 
as a distinct antipyretic upon fevered states, and is a slight depressant 
of normal bodily heat. The studies of Gedl, Fiirbringer, and See 
also show this, and those of Danewsky point to it. In the experiments 
of North upon man, after and during exercise, the antipyretic effects 
were marked. According to the author's studies, the drug lowers 
fever by diminishing heat-production and increasing heat-dissipation, 
but this is by no means positively decided as a fact. 

Absorption and Elimination. — Salicylic acid is absorbed from 
the stomach as a salicylate of sodium, and so circulates in the blood. 
It is eliminated by the kidneys and by all the secretions. In the urine 
it appears as salicyluric acid. According to Kolbe, after a dose of 1 
ounce (30.0) elimination does not commence for three hours, but 
Fleischer found the drug in the urine in one and a half hours. Usually, 
however, it is far more rapidly eliminated, and, as pointed out by 
Soullier, after a dose of 15 grains (1.0) it appears in the urine in ten 
to twenty minutes and after 30 grains (2.0) in five minutes. The 
elimination continues for a period of from thirty-three to fifty-six hours 
(Weill). The urine after very large doses is dark olive-green, and this 
change in color is due to the presence of indican and pyrocatechin, 
which are formed by the action of the pancreatic juices upon the drug 
in the intestine. The presence of salicyluric acid in the urine is to 
be discovered by the addition of a solution of the chloride of iron to 
that fluid, which causes the appearance of a violet color. 

Poisoning. — Salicylic acid when taken in excessive dose causes 
profuse sweating, roaring in the ears, dimness of vision, headache, 
partial or total deafness, and a decided fall in temperature. The 
pulse becomes weak and relaxed, and finally ptosis, strabismus, and 
general paralysis ensue. The urine and feces are passed involun- 
tarily, and the urine is olive-green in color. The respirations at first 
are quickened and deepened, but finally become shallow and feeble, 
death ensuing from respiratory failure. 



SALICYLIC ACID. 405 

If the dose is sufficiently large, the blood is involved and the 
corpuscles rapidly break down. 

Therapeutics. — Salicylic acid, owing to its close resemblance to 
quinine, was first introduced as an antiperiodic and antipyretic, but 
soon was found to be of inferior value in these states and of super- 
lative value in rheumatism. 

At present it is rarely if ever used for either of the former pur- 
poses, but is largely employed as a standard remedy for the latter 
disease. (See Rheumatism.) 

The value of salicylic acid in rheumatism limits itself solely to 
the relief of pain and the cure of the malady without preventing the 
complications incident to its course. That is to say, the changes in 
the joints or heart in rheumatism are only of less frequency after the 
use of salicylic acid because the drug shortens the disease, and not 
because it prevents these changes by a direct influence; this is also 
true of rheumatic hyperpyrexia, where salicylic acid is of service in 
shortening the attack, though it often fails to control the temperature 
to any great extent. In acute rheumatism 15 to 20 grains (1.0-1.3) 
should be given every four hours until marked physiological symptoms 
occur. With these doses it is wise to give 10 to 15 grains (0.60-1.0) 
of sodium bicarbonate to prevent irritation of the stomach and because 
clinical experience has shown that this combination acts better for 
the cure of the disease than the salicylates alone. Another method is 
to give 30 or 40 grains at 7 and 9 p.m., with a copious draught of 
milk, so that the main effects will be produced during sleep. It is to 
be remembered, however, that in many cases the salicylates seem to 
be of no value whatever, merely producing sweats and headaches, 
and it is also worthy of note that nothing else does these cases much 
good, as they seem bound to run a given course before the patient 
recovers. If a cure does take place, relapses are very common 
indeed, and the drug should always be continued for many days after 
all symptoms cease. Haig has proved that the salicylic compounds all 
aid in the excretion of uric acid, and thinks they relieve rheumatism 
in this manner. In gonorrheal rheumatism salicylic acid is of little 
value, for it has no influence upon the gonococcus in the joints. In 
rheumatoid arthritis it is valueless. The question as to the value of 
the salicylates in cases of gout is one open for debate. Some physi- 
cians regard it as useful, others as useless. Thus Duckworth states 
that in his experience and that of his friends the salicylates do not 
compare with colchicum. On the other hand, See, Jaccoud, and 
Haig find them useful. If they are of any value, it is only when the 
dose is very large, and even then their usefulness seems to be doubt- 
ful. In subacute rheumatism citrate or acetate of potassium may be 
used in place of salicylic acid in the dose of 30 to 60 grains (2.0-4.0), 
and these salts are to be taken just before going to bed. In lumbago, 
sciatica, and similar states salicylic acid is a very useful remedy. 
While it is not so good as phenacetin in neuralgia, it is of great 



406 DRUGS. 

service in the migraine of rheumatic persons, often curing the disease. 
(See article on Migraine.) 

Brunton has highly recommended the use of the salicylates with 
the bromides in the nervous irritability of gouty or lithsemic persons. 

Salicylic acid has been largely used for the removal of pleural effu- 
sion if the effusion be serous. Dock believes that the duration of 
treatment is less with the salicylates than by the use of diuretics, 
alteratives, or purgatives, but the author has not reached good results 
from this plan of treatment. The dose should be from 1 to 2 drachms 
(4.0-8.0) daily. Doses larger than this are not necessary. How sali- 
cylic acid does good in pleural effusion is not known, for its diuretic 
properties are not sufficiently great to drain away the liquid by this 
means. 

In quinsy or true tonsillitis the drug is thought by some practitioners 
to act as a specific, particularly when this condition is associated with 
a rheumatic tendency or goutiness. It will often prevent suppuration, 
shorten the attack, and relieve the pain and swelling. The doses 
should be small, say 3 grains (0.20) at each dose, and given hourly. 
In stomatitis, after the blisters have broken, the burning and pain are 
often intense, and a mouth-wash of salicylic acid in the proportion of 
1 to 250 of water is useful. 

Ringer recommends the use of the following salve in pruritus of 
the anus and vulva: 

fy— Acid, salicylic. . 3ij (8.0). 

01. theobromatis 5v (20.0). 

Cetacese 3iij (12.0). 

01. myristicse f3iss (6.0). — M. 

In the treatment of corns there is probably no better application 
than lint soaked in a solution of salicylic acid, or the use of the follow- 
ing formula as a paint, which should be applied after soaking the foot 
in hot water: 

1^ — Acid, salicylic . gr. xxx (2.0). 

Ext. cannab. indicse gr. v (0.30). 

Collodii f gss (16.0).— M. 

S. — Apply with a brush until a good coat is formed. 

After a few days the corn can be peeled off with ease. 

A useful salve for the soreness following horseback or bicycle riding 
is one composed as follows: 

1$ — Acid, salicylic. ........ gr. x (0.60). 

Adip. benzoinat !j (30.0). — M. 

S. — Apply to the sore part. 

A solution of salicylate of sodium or of bicarbonate of sodium, 
applied on lint to inflamed rheumatic joints, often gives great relief. 
Smearing an ointment of salicylic acid over the joints not only pro- 
duces good effects locally, but by absorption of the drug influences 
the disease. (See Rheumatism, Part IV.) 



SALIC YLIC A CID. 407 

In gastric dilatation or catarrh, where vomiting occurs and the 
matters vomited contain sarcina?, salicylic acid will be found of ser- 
vice, as it acts as an antiseptic in the stomach. In adults suffering 
from ascaris lumbricoides , or round-worms, salicylic acid may be used 
in the dose of 8 grains (0.5) every hour till 40 grains (2.60) are taken. 
This treatment should be followed by the use of a purge. For thread- 
or seat-worms the following injection will be found of service: 

fy— Acid, salicylic 3ss (2.0). 

Sodii borat gss (2.0). 

Aquae Oj (480).— M. 

S. — Warm, and inject into the bowels. For a child reduce this one-half in all 
its parts. 

In bromidrosis of the feet (excessive sweating with fetor) salicylic 
acid may be dusted over the parts, or the following powder used: 

Py — Acid, salicylic, 

Pulv. amyli aa gss (16.0).— M. 

S — Apply to the feet, 

In eczema of the face and hands, where the eczema is of the wet or 
weeping variety, salicylic acid, locally applied, is often of great service. 

]$ — Acid, salicylic gr. v vel x (0.3-0.60). 

Pulv. amyli 5ij (8.0). 

Pulv. zinci oxid 5ij (8.0). 

Petrolati §ss (16.0).— M. 

S. — Apply locally. 

If the eczematous process is subacute and needs stimulation, the 
salicylic acid may be increased to 20 or 30 grains (1.3-2.0). 

Contraindications to the use of the salicylates are meningeal inflam- 
mation or congestion, middle-ear disease, albuminuria, inactivity of 
the kidneys, particularly that occurring in pregnancy and in Bright's 
disease. 

Antiseptic Use. — Salicylic acid is employed as an antiseptic in the 
treatment of wounds as a local remedy and as a dressing, but should 
not be applied over too large an area, as it may be absorbed and pro- 
duce constitutional symptoms. As an application to small burns a 
mixture of 1 drachm (4.0) of salicylic acid to 8 ounces (240.0) of olive 
oil is of service. 

In the treatment of soft chancres and venereal sores salicylic acid 
has been largely used by some practitioners either as a salve or as a 
dusting-powder, as follows: 

fy — Acid, salicylic gr. xx (1.3). 

Alcohol gtt. xlv (3.0). 

Adipis benzoinat oij (60.0). — M. 

Py — Acid, salicylic gr. xv (1.0). 

Pulv. amyli vel cretae 3ij (8.0). — M. 



408 DRUGS. 

Salicylic acid may be added to urine to prevent its decomposition, 
but will sometimes cause the reactions for sugar to appear. Patients 
taking salicylic acid often notice that the urine is odorless after stand- 
ing, and that it will remain fresh for many days because of the salicyluric 
acid present in it. It may cause, when taken internally, the reaction 
of sugar in the urine with Trommer's test. 

Untoward Effects. — Salicylic acid, as already stated, may produce 
headache and roaring sounds in the ears. In persons with middle-ear 
disease it is contraindicated unless urgently called for, as it often 
makes the deafness permanently worse. Sometimes erythema or 
acne follows its employment, and blindness and retinal hemorrhages 
have occurred. Strumpell asserts that delirium of an active character 
sometimes appears after full doses of salicylic acid, which delirium is 
usually happy in its type, and is seen most commonly in young girls. 
Sometimes full doses produce visions which may be seen only when 
the eyelids are closed. It would be impossible to enumerate all the 
untoward effects which have been noted, but it is worthy of remark 
that very few deaths have taken place. 1 Binz thinks that full doses 
of salicylic acid may produce abortion in women who already have a 
tendency to abort, and Vineberg thinks that menorrhagia and metror- 
rhagia are caused by it. 

Administration. — Salicylic acid has a nauseous taste and is irritant 
to the stomach. It may be given in a solution of glycerin and water, 
or its taste may be masked by the use of syrup of bitter orange-peel 
or syrup of ginger. The following formulae may be used: 

1^— Acid, salicylic. 3ij (8.0). 

Tinct. lavandulse comp f 3iv (16.0). 

Glycerini fgss (16.0). 

Aquse destillat q. s. ad f gviij (240.0). — M. 

S. — A tablespoonful (16.0) every two hours. 

Or, 

1^— Acid, salicylic 3ij (8.0). 

Glycerini. f 5ss (16.0). 

Syrup, aurantii f Siv (120.0). 

Aquse destillat q. s. ad fgviij (240.0).— K. 

S. — A tablespoonful (16.0) every two hours. 

Salicylic acid may be used in pill or capsule, but as it is irritant 
to the stomach in so concentrated a form, it must be taken with water 
or milk, and should follow rather than precede meals. 

If buzzing in the ears produced by this acid is annoying, bromide 
of sodium in the dose of 20 grains (1.3) will generally give relief. 

Salicylic-acid ointment (Unguentum Acidi Salicylici, B. P.) is a 
useful preparation for external application in chronic, deep-seated 
skin diseases. 

1 See author's Boylston Prize Essay of Harvard University on Antipyretics. 



SALOL. 409 

Salicylate of Methyl. 

(See Gaultheria.) 



Salicylate of Sodium. 

Salicylate of Sodium (Sodii Salicylas, U. S. and B. P.) is a less 
irritant and somewhat less disagreeable preparation than salicylic 
acid. Its internal action, use, and doses are the same as those of the 
acid. It may be given by dissolving it in milk, and then adding 
rennet to produce a curd, which disguises the taste and protects the 
stomach. 

Other salicylates are largely used by some practitioners. Salicylate 
of lithium is supposed by some physicians to be of more value than 
the other salts. (See Aspirin and Salophen.) 

SALOL. 

Phenyl Salicylas, U. S., Salol, B. P., is a white crystalline powder, 
faintly aromatic and almost without taste. It is not soluble in water, 
but is in alcohol, and an alcoholic solution forms an imperfect emulsion 
when mixed with water. Salol is also slightly soluble in copaiba, in the 
oils of sandal-wood and of turpentine, and in mineral oils. This solu- 
bility is very useful in prescribing it with these remedies in certain 
diseases of the genito-urinary apparatus. (See Gonorrhoea.) 

Salol is a compound of 60 parts of salicylic acid and 40 of carbolic 
acid, and is decomposed by the pancreatic juice into these two sub- 
stances. For this reason overdoses are capable of producing symp- 
toms of carbolic-acid poisoning. Thus 20 grains of salol (1.3) taken 
five times a day will cause a man to take 40 grains (2.60) of carbolic 
acid, which is almost a poisonous dose. 

Hesselbach has proved that large doses of salol are very apt to 
affect the kidneys unfavorably, and rightly believes it to be contra- 
indicated in all cases of renal inflammation of an acute type. 

It is worthy of note that the drug rarely produces untoward effects, 
although at one time a number of observers accused it of frequently 
doing so. 

Salol is used for the same purposes as salicylic acid in the treat- 
ment of rheumatism when the stomach is so irritated that it cannot 
bear the latter drug, as salol is dissolved in the small intestine. A dose 
often used is 5 grains (0.30) an hour, but this is too much, as a rule, 
and may produce renal irritation. Salol is also useful in muscular 
rheumatism and neuralgia due to exposure. In pharyngitis 5 grains 
(0.30) of salol, given three times daily, is a valuable part of the treat- 
ment of the affection, and in persons subject to chronic sore throat 
due to the uric-acid diathesis this treatment will often produce ex- 



410 DRUGS. 

traordinary results. It is of the greatest use in duodenal catarrh and 
catarrhal jaundice to arrest intestinal fermentation. 

In the treatment of gonorrhea in all its stages salol may be employed 
by the mouth, as in its elimination it sterilizes the urine and tends 
to disinfect or sterilize the urethra at each act of micturition. (See 
Gonorrhoea.) 

Salol is of great value in intestinal indigestion and fermentation, 
and is sometimes used in cases of mild or pernicious anamia when 
it is thought that the development of decomposition products is their 
cause. (See Ansemia.) In diarrh&a dependent upon such causes salol 
is one of the best remedies we have, since it renders the intestinal 
canal antiseptic, and so removes the cause of the disorder, instead of 
locking the putrid material in the bowel, as does opium. In cholera 
morbus the following is very useful: 

1$ — Phenyl salicylatis 5j (4.0). 

Bismuth, subnitrat 5ij (8.0). 

Misturse cretse q. s. ad fgiij (90.0). — M. 

S. — Two teaspoonfuls (8.0) every two hours. 

Wide experience with the drug in the treatment of cholera during 
recent epidemics has proved it to be one of the best remedies that can 
be employed in the treatment of this disease. 

Salol may be given in wafers, capsules, or pills, in the dose of 5 
grains (0.3) or more. 

SALOPHEN. 

Salophen (Salophenum) has been introduced into medicine as a sub- 
stitute for salol, and is said to possess the advantage of being far less 
poisonous than salol, because in this case the phenol of the salol is 
replaced by a compound of phenol which is innocuous. Experiments 
on animals seem to indicate that these theoretical advantages are 
present in fact. Like salol, salophen is broken up in the intestine by 
the juices there present, and the result is salicylic acid and acetyl- 
paramidophenol. Salophen contains about 10 per cent, less salicylic 
acid than does salol (51 per cent.), and appears in the form of thin, 
white laminse nearly insoluble in water. It is tasteless. 

Therapeutics. — For the therapeutics of salophen the reader is referred 
to the article on Salol, as the indications for both drugs are identical, 
save that salophen can probably be used when salol cannot be em- 
ployed. The dose of salophen is from 5 to 20 grains (0.30-1.3) three 
times a day. It can be very effectually combined with phenacetin 
in the treatment of neuralgia. In subacute rheumatic affections it is 
certainly very useful. 

SANDAL- WOOD OIL. 

Sandal-wood Oil (Oleum Santali, U. S. and B. P.) is derived from 
the wood of Santalum album, a tree of India, and has a hot, burning 
taste. The odor is very pleasant, and the oil has been used as a per- 



SANTONIN. 411 

fume. In overdose the oil is capable of producing great irritation of 
the genito-urinary passages. 

Therapeutics. — The oil of sandal-wood is much used by genito- 
urinary surgeons in chronic gonorrhoea and gleet for the purpose of 
stimulating depraved mucous membranes to proper action, and in 
chronic cystitis to act as a tonic to the bladder. 

In the subacute or later stages of bronchitis, when the expectoration 
is thick and ropy and the cold is not readily "thrown off," the oil 
of sandal-wood is efficacious. Daggett strongly recommends its use 
in cases of asthma associated with marked catarrhal symptoms, and 
'in the excessive cough following influenza it is of great value. In 
all cases it should be given in capsule in the dose of 5 to 20 minims 
(0.30-1.3), 5 minims (0.30) being usually sufficient, although drug- 
gists generally keep it in 10-minim (0.60) capsules. Oil of sandal- 
wood may irritate the stomach, but it is not so apt to do so as is cubebs 
or copaiba. 

SANGUINARIA. 

Sanguinaria, U. S., or Blood-root, is the rhizome of Sanguinaria 
canadensis, and has been largely used in medicine, but is a dangerous 
remedy, possessing more power for harm than good. Its chief alkaloid 
is sanguinarine. 

Poisoning. — Sanguinarine in poisonous dose causes vomiting, purg- 
ing, profuse salivation, and finally tonic convulsions which are spinal 
in origin. Death is due to respiratory failure, but the circulation is 
much decreased in force and frequency. 

Therapeutics. — The employment of sanguinaria in chronic bron- 
chitis is about the only purpose for which it is now employed to any 
extent. As an emetic in croup it has been largely used, but is too 
irritating and depressing, and ought not to be so employed. According 
to Bartholow, the drug acts as an hepatic stimulant, and is of service 
in g astro-intestinal catarrh and jaundice. 

Administration.— The dose of the fluid extract (Fluidextr -actum 
Sanguinaria?, U. S.) is 1 to 5 minims (0.05-0.30) as an expectorant, 
or 10 to 30 minims (0.60-2.0) as an emetic. If the drug does not 
cause vomiting after an emetic dose, it must not be allowed to remain 
in the stomach, as it is poisonous. The tincture ( Tinctura Sanguinaria?, 
U. S.) is the best preparation to use, and may be given in 20- to 30- 
minum (1.30-2.0) doses as an expectorant, and 1 to 3 drachms 
(4.0-12.0) as an emetic. The vinegar (Acelum Sanguinaria:) is no 
longer official, but is given in the dose of 10 to 30 minims (0.60-2.0), 
and as an emetic in the dose of 2 to 4 drachms (8.0-16.0). 

SANTONIN. 

Santoninum, U. S. and B. P., is neutral in principle derived from 
Levant Worm-seed or Santonica, which is the unexpanded flower- 
heads of Artemisia pauciflora (Maritima, B. P.), a plant of Asia 



412 DRUGS. 

Minor and Turkestan. Santonin is soluble in alcohol and chloro- 
form, but less so in water. Santoninic acid is formed by warming 
santonin with alkalies, and Hesse has found that santonin is an 
anhydride of santoninic acid. Santoninic acid is more soluble than 
santonin. 

Poisoning. — Santonin causes, when taken in overdose, muscular 
tremors, convulsive movements, unconsciousness, and sometimes epi- 
leptiform convulsions. 

One of the most common symptoms of the poisoning is chroma- 
topsia or xanthopsia, during the existence of which all objects look 
yellow. This is due to the staining of the humors of the eye by the 
drug. This may go on to total blindness or pass away in a few days. 
If the vision is not yellow, it may be green. The urine is also stained — ■ 
first yellow, then saffron, and finally purple-red, or is bloody-looking. 
This is not due to the presence of blood, but to the drug. Poisonous 
doses of the drug do not cause gastro-enteritis. 

Therapeutics. — Santonin is used for the removal of the round-worm, 
and is very efficacious. It has no influence on the tape-worm. It 
should be given in the manner of all vermifuges (see Worms) — namely, 
at a time when the alimentary canal is empty. Santonin is said to 
have a distinct influence over vision, increasing, in medicinal amount, 
its acuity whenever the optic nerve is at fault. In urinary incontinence 
santonin will often produce a cure after all other remedies fail. 

Santoninate of sodium (Sodii Santoninas) is a useless, harmful 
preparation, never to be employed except for the benefit of the eye 
when vision fails through disease of the optic nerve. Introduced 
into medicine because of its solubility, it is absorbed into the system, 
which is just what is least desired in an anthelmintic, which should 
seek the worm in the bowel, not by entering the blood. In eye affec- 
tions the dose may be from 2 to 8 grains (0.12-0.50) a day, accord- 
ing to the age of the adult. 

Santonin may also be given in the dose of 1 to 2 grains (0.06-0.12) 
to an adult in capsule or wafer. The crystals should be used, not 
the powdered santonin. Immediately after the drug is used, a 
2- or 3-grain (0.12-0.20) dose of calomel is to be taken, and followed 
by a saline purge six hours later, as the flow of bile caused by 
the mercurial is particularly useful in making the worm let go its 
hold. 

Untoward Effects. — In addition to the curious effects already named 
santonin may cause urinary incontinence even in medicinal dose. 

Administration. — Santonin is best given in the form of a troche or 
lozenge (Trochisci Santonini, U. S. and B. P.), 1 grain (0.06) each, 
but it is to be distinctly borne in mind, and written on the prescrip- 
tion, that the Trochisci Sodii Santoninatis of the U. S. P. of 1880 
are not to be sold to the patient. The troches of santonin itself are 
now official in the U. S. P., but if the physician prefers to write for 
troches, they can be made as follows: 



SA VINE. 413 

Py — Santonini gr. v (0.3). 

Pulv. sacchari alb 5iij (12.0). 

Pulv. acacise gr. viij (0.5). 

Misce bene, et adde 

Acacise mucilag gtt. xvj (1.0). 

Aquae q. s. 

Ft. in troches No. x. 

S. — One or two lozenges, as directed. 

SARSAPARILLA. 

Sarsaparilla, U. S., is the root of Smilax officinalis, Smilax ornata, 
and other species of Smilax, growing chiefly in Central America. It is 
known in the B. P. as Sarsce Radix. The drug is devoid of any marked 
physiological action, yet seems to possess some power over the general 
condition of the system. Thus while sarsaparilla seems utterly with- 
out effect in the hands of most physicians when given alone, it often 
seems to do good and to increase the effects of other drugs when com- 
bined with them, so that some cases of syphilis which are of an obsti- 
nate character are said to yield to iodide of potassium and sarsapa- 
rilla when the iodide alone fails. Sarsaparilla is largely used in 
domestic medicine as a " blood-purifier," and is a prominent con- 
stituent of many patent medicines. It is useless for such purposes 
and is a much overrated remedy. 

Administration. — Sarsaparilla is most commonly given in the form 
of the compound syrup (Syrupus Sarsaparilla Compositum, U. S.), 
composed of sarsaparilla, sassafras, liquorice, gaultheria, anise, and 
senna, dose 1 to 4 fluidrachms (4.0-16.0). (See Iodide of Potassium.) 
The other official preparations of the U. S. P. are the compound fluid 
extract (Fluidextr actum Sarsaparilla Compositum) , similar to the syrup 
in composition, dose J to 1 fluidrachm (2.0-4.0) ; and the fluid extract 
(Fluidextr actum Sarsaparilla) , dose | to 1 fluidrachm (2.0-4.0). The 
B. P. preparation is a liquid extract (Extractum Sarsa Liquidum), 
dose i to 4 fluidrachms (2.0-16.0); and Liquor Sarsa Compositus 
Concentratus, dose 2 to 8 drachms (8.0-30.0). 

i 
SAVINE. 

Sabina, U. S., is the tops of Juniper us sabina, an evergreen shruo 
of Northern Europe, Asia, and America. It contains and official 
volatile oil (Oleum Sabina, U. S.). Locally applied, it is more of a 
counterirritant than is turpentine, and if swallowed in poisonous 
amount causes nausea, vomiting, gastro-enteritis, unconsciousness, 
suppression of urine and death. If the individual be a pregnant 
female, abortion takes place as death approaches, but very rarely 
before this time. Profuse flooding nearly always accompanies the 
abortion and the drug cannot be used to empty the uterus with any 
safety. 



414 DRUGS. 

Therapeutics. — The oil, taken in the dose of 5 to 10 minims (0.30- 
0.60), repeated every three or four hours, acts as a powerful stimulant 
to the uterus and ovaries, causing hyperemia and aiding in the pro- 
duction of menstruation in cases of amenorrhoea. It may also be 
employed with advantage in some cases of menorrhagia. The drug is 
best given in emulsion or capsule. The fluid extract (Fluidextractum 
Sabince, U. S.) is given in the dose of 5 to 15 minims (0.30-1.0). 



SCAMMONY. 

Scammonium, U. S., Scammonia? Radix, B. P., is a gum-resin from 
the root of Convolvulus scammonia, growing in Asia Minor and 
Syria. Its active principle is sometimes called jalapin. 

Therapeutics. — Scammony is an irritant, drastic, hydragogue purge, 
which causes a good deal of griping and exerts a cholagogue effect. 
If an inflammatory condition of the bowels is present, its use is contra- 
indicated. 

The ingestion of poisonous doses is to be followed by treatment 
suitable for gastro-enteritis. Scammony is given in the dose of 2 to 5 
grains (0.12-0.30), always in combination with some other similar 
drug — as, for example, colocynth. Scammony forms part of the com- 
pound extract of colocynth (Extractum Colocynthidis Compositum, 
U. S. and B. P.), the dose of which is 1 to 3 grains (0.12-0.20) as a 
laxative or 5 to 20 grains (0.30-1.3) as a purge. The resin (Resina 
Scammonii, U. S.; Scammonice Resina?, B. P.) is given in the dose 
of 3 to 8 grains (0.20-0.50). The B. P. preparations of scammony 
are Pilida Scammonii Composita, dose 5 grains (0.30); and Pulvis 
Scammonii Compositus, dose 10 to 20 grains (0.60-1.3). The last two 
preparations are composed of scammony, ginger, and jalap. 



SCOPOLAMINE. 

Scopolamine, or Hyoscine, is an alkaloid derived from scopola 
(U. S.) the root of Scopolia atropoides, a plant of Southern Europe, 
which possesses medicinal powers closely resembling those of bella- 
donna and its sister drugs. Its physiological action is closely allied to 
that of the alkaloids of hyoscyamus. As stated in the article on 
Hyoscine, it has been introduced in its stead. The terms hyoscine 
and scopolamine are used interchangeably. (See Hyoscine.) 

Hyoscine itself is rarely employed, the hydrobromide (Scopolamine 
Hydrobromidum, U. S.) being preferable. It also occurs as the hydrio- 
date and hydrochloride. 

The extract of scopola (Extractum Scopola?, U. S.) is given in the 
dose of i to \ grain (0.008-0.015) and the fluid extract (Fluid- 
extractum Scopola?, U. S.) in the dose of \ to 3 minims (0.025-0.20). 



SCOPARWS AND SPARTEINE. 415 



SCOPARIUS AND SPARTEINE. 

Scoparius, U. S. (Scopari Cacumina, B. P.), or Broom, is the 
tops of Cytisus scoparius. It contains scoparin and sparteine, the 
first being a crystalline principle and the second a liquid alkaloid. 
The second (sparteine) is the alkaloid used in medicine in the form of 
a sulphate (Sparteine? Sulphas, U. S.), which is a crystalline salt readily 
soluble in water. 

Physiological Action. — As scoparius depends for its medicinal value 
almost entirely upon sparteine, what is here said applies to both the 
crude drug and the alkaloid. 

Nervous System. — Sparteine acts on the nervous system very 
decidedly if given in large doses, depressing the brain and spinal cord, 
chiefly in the motor tracts of the latter, thereby causing a decrease of 
reflex action and motor power, ending in complete paralysis. These 
changes occur both in man and in the lower animals. 

Circulation. — Upon the circulation sparteine acts as a stimulant. 
It quickens the pulse-rate in moderate doses, and also raises arterial 
pressure. The force of the contraction • of the ventricles is also in- 
creased. In large poisonous doses the drug acts as a circulatory 
depressant. 

Respiration. — Upon this function sparteine, in small amounts, 
has no effect, but poisonous doses kill by paralysis of the respiratory 
centre. 

Poisoning. — The symptoms of poisoning consist in trembling and 
inco-ordination of movement, and clonic and tonic convulsions, fol- 
lowed by a second stage of depression of the nervous system and 
general enfeeblement. 

Therapeutics. — Sparteine has been recommended in all states of 
the heart in which digitalis is of service, and it is sometimes useful 
in those fairly frequent cases where digitalis fails. In cardiac arrhythmia 
or palpitation it is thought to be of great service by those who have 
used it most. Clark found it of value in Graves' disease and in nearly 
every circulatory abnormality, but in the judgment of the author 
sparteine is not a very useful drug — one only to be turned to as a 
last resource after more generally used remedies fail ; or, in other words, 
it is not a remedy to be employed as a " stand-by " in the manner in 
which digitalis is used. 

While some clinicians have found sparteine of value, many have not. 
In the few cases in which it has been used by the writer it failed to 
be of service, perhaps because the cases were desperate and the drug 
was tried after all the other remedies had failed. The dose is as variable 
as its action. Some state it to be 2V g ram (0.003), while still others 
recommend 2 to 4 grains (0.12-0.25). A small dose should be used 
at first, and rapidly increased until some effects ensue. To get the 



416 DRUGS. 

best effects it should be given every two hours in the dose of \ grain. 
The drug should be given in watery solution. 

Potts claims to have found sparteine of value in the treatment of 
tremor, as in paralysis agitans, in the dose of \ to J grain (0.015- 
0.03) three times a day. 

Scoparius itself is used in decoction, made by adding \ ounce (16.0) 
of the broom-tops to a pint (480) of water, and boiling them down to 
a i pint (240). Of this, an ounce should be taken every three houis. 
This decoction is one of the most efficient diuretics in cardiac dropsy. 
The official preparations of the B. P. are an infusion (Infusum 
Scoparii), and the juice (Succus Scoparii), dose 1 to 2 drachms 
(4.0-8.0). 



SEIDLITZ POWDER. 

Under the official name of Pulvis Effervescens Compositus the U. S. P. 
recognizes a purgative powder {Pulvis Soda? Tartar ata? Effervescens, B. 
P.) made by taking the bitartrate of sodium and potassium, or Rochelle 
salt, 120 grains, and bicarbonate of sodium 40 grains, which are 
wrapped in blue paper, and 35 grains of tartaric acid placed in a 
white paper. The contents of each paper are dissolved in water — 
half a tumblerful — and the two solutions added to one another 
and swallowed during effervescence. As much as two powders may 
be used, but this is generally too large an amount unless full purgation 
is needed. In sick stomach associated with constipation, when a whole 
powder cannot be retained, the two powders should be divided into 
fourths, and a fourth added to a fourth dissolved in a half-wineglassful 
of water and taken every fifteen minutes until the entire powder is 
ingested. This will often settle the stomach and produce pur- 
gation. 



SENEGA. 

Senega, U. S. (Senega? Radix, B. P.), is the root of Polygala senega, 
a small plant of the United States, containing a principle known as 
polygalic acid and senegin. 

Therapeutics. — Senega is used in medicine as a stimulating expec- 
torant in the subacute and chronic forms of bronchitis. It has also 
been employed as a diuretic in cardiac dropsy or that due to renal 
disease. In cardiac disease it should not be used, and indeed it is 
rarely employed at present except in combination with other drugs in 
expectorant mixtures. 

Administration. — Senega is used in the form of the fluid extract 
(Fluidextr actum Scnegoe, U. S.), dose 10 to 20 minims (0.60-1.3) and 
the syrup (Syrupus Senega?, U. S.), dose 1 to 2 drachms (4.0-8.0). It 



SENNA. 41 7 

is also used in Coxe's Hive Syrup. The official preparations of the 
B. P. are — a tincture (Tinctura Senega?), dose 1 to 2 drachms (4.0-8.0), 
and an infusion (Injusum Senegce), dose 1 to 2 ounces (30.0-60.0). 



SENNA. 

Senna, U. S., is the most drastic of the laxative purges used for the 
relief of constipation. It is the leaflets of Cassia acutijolia and Cassia 
angustifolia, and contains a very acrid irritant purgative principle 
known as cathartic acid. Senna is official in the B. P. as Senna Indica 
and Alexandrina. 

Physiological Action. — Senna acts as a purge, producing copious 
stools, often with much griping if it is used alone. According to 
Rutherford and Vignal, it materially increases the flow of bile, but 
it is seldom, if ever, used in medicine as a cholagogue, although, 
according to Prevost and Binet, cathartic acid has an influence over 
biliary secretion. Hess has found that the drug acts directly as a 
stimulant upon the mucous membranes, and so produces a local peri- 
stalsis as it is moved along. It is also known that the drug is 
eliminated in the milk, and for this reason care should be taken in 
giving the drug to nursing mothers, as it will purge the nursling. 

Administration. — Senna is generally combined with other drugs 
for the relief of constipation, but may be used alone. If this is done, 
the fluid extract (Fluidextr actum Senna?, U. S.) may be employed in 
the dose of 1 to 2 drachms (4.0-8.0) to a child or 4 drachms (16.0) 
to an adult. It is, however, always better to give children the more 
agreeable confection (Confectio Senna? , U. S. and B. P.) in the dose of 
| drachm (2.0) to a child, or 1 to 2 drachms (4.0-8.0) to an adult. As 
the confection is apt to cause gastric disorder if used continuously 
because of the sugar contained in it, its use is limited to a small class 
of cases. 

In the treatment of the constipation of pregnancy senna is thought 
to be very useful. In these cases and in others where cascara sagrada 
alone will not move the bowels, senna may be prescribed as follows: 

J^— Ext. sennae fluid. . . . . . . f §ij (60.0). 

Ext. cascarse sagradae fl. . . . . . f§j (30.0). — M. 

S. — Teaspoonful (4.0) at night, or night and morning. 

Should this produce griping, \ to 1 minim (0.025-0.05) of fluid extract 
of belladonna may be added to each dose. Under the name of Black 
Draught a mixture of senna, manna, fennel, and sulphate of magnesium 
has been largely used (Injusum Senna? Compositum, U. S.) in the dose 
of 4 ounces (120.0). It is an active hydragogue purge. The syrup 
(Syrupus Senna?, U. S. and B. P.) is given in the dose of 1 to 4 drachms 
(4.0-16.0). 

27 



418 DRUGS. 

One of the best ways to use senna is in the compound liquorice 
powder (Pulvis Glycyrrhizce Compositus, U. S. and B. P.), which is 
a good laxative in the dose of 20 to 30 grains (1.3-2.0). Compound 
liquorice powder is composed of senna, liquorice, oil of fennel, washed 
sulphur, and sugar. 

Injusum Serines, B. P., is given in the dose of 1 to 2 ounces (30.0- 
60.0); Mistura Sennoe Composita, B. P., in the dose of 1 to 2 ounces 
(30.0); and Tinctura Serines Composita, B. P., in the dose of 1 to 4 
drachms (4.0-16.0). Liquor Senna? Concentratus, B. P., is given in the 
dose of 1 drachm (4.0). 

Senna, because of its chrysophan, may stain the urine carmine if 
that fluid is alkaline, or yellow if it is acid. No alarm should be felt 
if either color appears in this secretion. Often it is necessary to warn 
the parents of a child of the possibility of such an occurrence, in order 
to prevent alarm on the part of the mother, who otherwise might 
think that hematuria was present. 

SERPENTARIA. 

Serpentaria, U. S. (Serpentaria? Rhizoma, B. P.), or Virginia Snake- 
root, is the rhizome and rootlets of Aristolochia serpentaria and Aristo- 
lochia reticulata, plants of the Southern United States. It contains an 
active principle, aristolochin, which is never used in medicine. 

Therapeutics. — Owing to the rather pleasant, warm taste of ser- 
pentaria, and the fact that it stimulates secretion, it is used largely as 
a vehicle for other more potent remedies. It has tonic properties, 
and in consequence has been largely used in the treatment of atonic 
dyspepsia and indigestion. It is said to be a sexual stimulant, but 
this is doubtful, to say the least. In overdose it is an irritant, and 
will cause vomiting and purging if large amounts are taken. 

Administration.— Serpentaria is given in the form of the fluid extract 
(Fluidextractum Serpentaria?, U. S.) in the dose of 10 to 40 minims 
(0.60-2.6), and the tincture (Tinctura Serpentaria, U. S. and B. P.) 
in the dose of J to 1 drachm (2.0-4.0). It also enters into Huxham's 
Tincture of Cinchona (Tinctura Cinchona? Composita, U. S. and B. P.). 
Injusum Serpentaria?, B. P., is given in the dose of 1 to 2 ounces 
(30.0-60.0). 

SILICATE OF POTASSIUM OR SODIUM. 

Soluble Glass, or Silicate of Potassium or Sodium, occurs as a clear, 
syrupy fluid. It is used as a splint in the dressing of fractures and 
sprains, as it rapidly becomes hard and immovable when painted over 
the bandages. Silicate of. potassium or sodium may be universally 
substituted for plaster of paris. The solution of silicate of sodium is 
no longer official. 



SOAP. 419 



SOAP. 



Sapo, U. S. (Sapo Durus, B. P.), is prepared from any alkali and 
fixed oil, although soda and olive oil are most frequently employed 
in the manufacture of the soaps which are used medicinally. Castile 
soap, if good, is the best representative of a pure soap. 

Soap may be cut into the form of a suppository and used to pro- 
voke movements of the bowel in young children who are suffering 
from constipation, by placing it just inside the anus, having previously 
dipped it into water an instant to make it slippery. It may also be 
used as an enema, dissolved in warm water, or a mixture known in 
Philadelphia as the "House Mixture" may be employed in the case 
of an adult. This consists of a mixture of water, soft-soap, and molasses 
in varying proportions, and if flatulence is present turpentine and olive 
oil are added to it. The preparation is as efficient as it is cheap aud 
dirty. Soap is also used as an antidote to many poisons and as an aid 
to emetics. 

Green Soap (Sapo Mollis, U. S. and B. P.) is not generally green, 
but brown. It is a soft soap made by the use of potash and olive oil, 
and is largely used by dermatologists in the treatment of eczema and 
similar skin diseases where a detergent, stimulating application is 
needed. It is sometimes called " German soft soap," to distinguish it 
from the ordinary soft soap, or the common sapo mollis, of the United 
States, which is an impure substance often made of rancid fats, 
containing a large excess of alkali and never used except for scour- 
ing purposes. Green soap is employed not only as green soap, 
but also in the liniment (Linimentum Saponis Mollis), which is to 
be thoroughly rubbed into the part when used medicinally, well 
washed off, and afterward simple cerate or some other soothing salve 
applied. 

Soap Liniment (Linimentum Saponis, U. S. and B. P.), or Opo- 
deldoc, as it is called in domestic medicine, is largely used for rubbing 
stiff muscles and sprains. It is generally employed to carry more active 
external remedies, such as opium or aconite. 



1$ — Tinct. aconiti, 

Tinct. belladonnae, 

Tinct. opii . . aafgij (8.0). 

Liniment, saponis . . . . q. s. ad f J vj (180.0). — M. 

Soap plaster (Emplastrum Saponis, U. S. and B. P.) is used as a 
thick, heavy protective for bed-sores or where the formation of bed-sores 
is feared. It is also used as a support about sprained joints. 



420 DRUGS. 

SODIO-SALICYLATE OF THEOBROMINE. 

This compound, known as Diuretin (or sodio-theobromine-salicy- 
late), derives its name from the extraordinary power which it is said to 
possess of producing a great increase in the urinary flow from the 
kidneys. This power depends entirely upon the theobromine, which 
is a crystallizable, volatile, bitter alkaloid, closely allied to caffeine 
and xanthine, and derived from the seeds of Theobroma cacao, or 
the source of ordinary chocolate. Owing to the insolubility of theo- 
bromine, it has been found necessary to combine it with sodium 
salicylate, as under these conditions it is readily absorbed. 

The diuretic properties of this alkaloid were first discovered during 
a series of experiments made by Schroder, in Strasburg, in 1889, who 
found that the diuresis produced in man and the lower animals was 
marked. Many clinical trials in Europe and America have confirmed 
his observations, but there are a number of cases in which it signally 
fails, particularly in chronic Bright's disease. 

Theobromine does not have so stimulating an effect on the heart as 
does its relative caffeine, so that the circulatory effect, while showing 
a stimulant rather than a depressing tendency, is very slight. It slightly 
increases muscular power, but its peculiar affinity for the renal struc- 
tures surpasses all its other activities. 

As the action of the drug depends upon its ability to stimulate the 
secreting epithelium of the kidney, the physician should remember 
that in cases of advanced renal disease, where the secreting structures 
are almost entirely destroyed, no result can be expected from its 
administration; but it is probable that the drug is useful in almost 
all conditions of dropsy, whether due to renal inactivity or cardiac 
disease, and is harmless to the patient even if the diuretic effect does 
not ensue. The only contraindication to the use of theobromine or 
diuretin is the presence of acute nephritis, when, of course, sedatives 
rather than stimulants are needed. So far as the writer is aware, no 
study as to the proportion of solids and liquids in the urine of patients 
under the influence of this drug have been made, but the fact that it 
stimulates the epithelium or secreting structures of the kidney would 
indicate that the solids are increased. 

As diuretin contains only from 30 to 50 per cent, of theobromine, 
it has to be given in very large amounts, as much as 1 to 2 drachms 
(4.0-8.0) in twenty-four hours, preferably in divided doses of from 
10 to 20 grains (0.60-1.3) in capsule or in warm water. The former 
method is the better, as the taste of the drug is disagreeable and soapy. 

Diuretin must not be exposed to the air, as it undergoes decom- 
position. 

In all the cases in which the writer has tried sodio-salicylate of theo- 
bromine he has failed to see any effect produced, and, while he has no 
confidence in the drug, he mentions it because others claim to have 
obtained good results from its use. 



SODIUM. 421 



SODIUM. 



Sodium is a metallic element, the salts of which are usually white 
and colorless. It is not used in medicine, but many of its salts are 
employed. While potassium acts as a depressant to the body, sodium 
seems to exert comparatively little effect upon the animal economy. 
The salts vary in their power with the acid forming them. (See Ben- 
zoate of Sodium, Chloride of Sodium, Salicylate of Sodium, etc.) 

Acetate of Sodium (Sodii Acetas, U. S.) is rarely if ever used in 
medicine as a substitute for acetate of potassium. The dose is 20 to 
40 grains (1.3-2.60) three times a day. 

Sodium Bicarbonate. 

Bicarbonate of Sodium (Sodii Bicarbonas, U. S. and B. P.) is largely 
used as an antacid in gastric fermentation and in sick headaches arising 
from this condition. Combined with calomel in powder, it certainly 
adds to its efficiency in increasing biliary flow, as all alkalies of this 
class liquefy and thin the bile. The drug has been widely employed 
in the treatment of rheumatism, and is found to be of great service 
in allaying pain and soreness in the joints when used in a lotion made 
by dissolving it in water and applying it to the part on lint or rags. 
In acidity of the stomach the following effervescing powder is useful: 
Bicarbonate of sodium (Sodii Bicarbonas) , 30 grains (2.0) in one paper, 
and in the other 5 grains (0.3) of tartaric acid (Acidum Tartaricum). 
These are each dissolved in half a tumbler of water, added to one 
another, and swallowed during effervescence. 

Sodium Cacodylate. 

Cacodylate of sodium is a white amorphous powder which readily 
dissolves in water. Its uses in medicine are practically identical with 
those of arsenic. (See Arsenic.) The drug is capable of being admin- 
istered hypodermically without disagreeable local or general symptoms. 
It has seemed to act well in the debility and anosmia of tuberculosis. 
The dose is \ to \ grain (0.015-0.03) subcutaneously, and 2 to 4 grains 
(0.12-0.25) by the mouth. Some of those who have used it most assert 
that its use by the stomach causes not only a strong, garlicky odor on 
the breath, but also gastric irritation. 

Gautier has advised the following formula for hypodermic use: 

i& — Sodii cacodylat '. . gr c (6.6). 

Aquae destillat fgiij (90.0). 

Phenolis . n\J (0.05). 

This mixture is to be boiled, filtered through a sterile filter, and 3 
ounces (90.0) of distilled, sterile water added. The hypodermic dose 
of this is from 15 to 20 minims (1.0-1.3). 



422 DRUGS. 

It is important to remember that the reason cacodylate of sodium 
can be taken in such large doses is that it is too stable to be broken 
up in the body, and therefore is, in large part, useless for the purpose 
of producing a rapid arsenical effect. 

Sodium Chloride. 

Chloride of Sodium (Sodii Chloridum, U. S. and B. P.), or Common 
Salt, is a useful drug and food, aiding in maintaining the alkalinity 
of the blood and tissues and in the formation of gastric juice, being 
changed by the lactic acid of the stomach into lactate of sodium, 
thereby setting free hydrochloric acid, which acts not only by aiding 
digestion, but in the production of pepsin from the pepsinogen of the 
gastric tubules. The dose is 10 to 20 grains (0.60-1.3). 

Sodium Ethylate. 

Sodium Ethylate is a whitish powder, decomposed in the presence 
of water into alcohol and caustic soda, but soluble in absolute alcohol 
without decomposition. 

Sodium ethylate is employed in medicine as a depilatory — that is, 
for the purpose of removing hairy growths. To accomplish this pur- 
pose it is necessary that the growth be clipped close to the skin, and 
that the drug be dissolved in absolute alcohol and applied over the 
roots of the hair with a glass rod. Soon after this application a crust 
forms, which should not be detached for two or three weeks, but 
which, on its removal at the end of this time, generally shows that 
all the roots of the hair have been destroyed. If not, the operation 
may be repeated as soon as the skin is in a condition to bear it. 
To prevent pain, a 5 per cent, solution of cocaine may be used 
hypodermically at the spot to be cauterized. It is worthy of remem- 
brance that moles and small birthmarks, or nsevi, may be removed 
by a similar application. Small scars may result. 

A solution, Liquor Sodii Ethylatis, is official in the B. P. 



Sodium Sulphate. 

Sodii Sulphas, U. S. and B. P., or Glauber's Salt, is one of the most 
irritant of the saline purges, rarely used in medicine for human beings, 
but largely employed by veterinarians. The purgative dose for man 
is \ to 1 ounce (16.0-30.0). If any intestinal inflammation is present, 
it is contraindicated. It produces large watery stools, with a good 
deal of griping. Sulphate of sodium is a prominent constituent of 
Carlsbad water, Hunyadi Janos, Hunyadi Arpad, and similar waters. 
(For an explanation of the action of salines in producing purgation, 
see Magnesium Sulphate.) 

Reverdin has recently claimed that small doses of 2 grains (0.12) of 



SOMNAL. 423 

sulphate of sodium every hour are of great value in controlling capil- 
lary hemorrhages and for graver hemorrhages. It must be given by 
the mouth or intravenously. If given hypodermically he asserts it is 
useless. 

Under the name Sodii Sulphas Efjervescens the B. P. recognizes an 
effervescent preparation of sodium sulphate, given in the dose of 2 
to 4 drachms (8.0-16.0). 

Sodium Sulphocarbolate. 

(See Phenolsulphonates.) 

Sodium Thiosulphate. 

Thiosulphate of Sodium, U. S. or Hyposulphite of Sodium, occurs 
in large, transparent, colorless plates which effloresce when exposed 
to the air. It has a slight alkaline reaction, and is soluble in about 
equal parts of water, but insoluble in alcohol. 

Therapeutics. — Thiosulphate of sodium is used in the proportion 
of 1 drachm (4.0) to the ounce (30.0) of water or lard in the treatment 
of parasitic skin diseases, particularly those due to the tricophyton 
fungus, such as pityriasis versicolor. It is also efficacious, locally 
applied, -in rhus poisoning, and in cases of pruritus due to other 
causes, in the strength of \ drachm (2.0) to the ounce (30.0) of 
water. In malarial hematuria hyposulphite of sodium is often given 
with advantage in the dose of from 10 to 30 grains (0.60-2.0) every 
four hours. How it acts in this condition is not known. 



SOLANUM CAROLINENSE. 

Solanum Carolinense, or Horse Nettle, is a low perennial plant of 
the natural order Solanaceee, a native of the Southeastern United 
States. 

According to studies made by Thornton, the drug depresses the 
cerebrum, but excites the spinal cord. It has been introduced into 
medicine for the purpose of relieving epilepsy, particularly when the 
disease occurs in childhood. In a limited employment of the drug 
the author has found it serviceab e in diminishing the frequency and 
severity of the attacks. The beginning dose of the fluid extract is 
15 to 60 minims (1.0-4.0) three times a day, but it may be increased 
to as much as 2 drachms (8.0) at a dose with advantage. 

SOMNAL. 

Somnal is stated to be ethylated chloral urethane, and seems to 
possess marked hypnotic power. It is a clear, colorless liquid, possess- 



424 DRUGS. 

ing a hot, burning taste, resembling that of sweet spirit of nitre. The 
dose is 20 to 40 minims (1.3-2.6) in liquorice-water or syrup of rasp- 
berry, and the sleep produced by it is said to last seven to eight 
hours. In a number of cases in which the writer has used it, it 
acted satisfactorily, although drowsiness was usually present the 
next day. 

S0Z0I0D0L. 

Sozoiodol is an antiseptic preparation first made and employed by 
one of our own countrymen in San Francisco, but at that time the 
preparation of it was so imperfectly carried out that foreign matters 
made it too irritating for general use. It was therefore discarded, 
only to be better prepared and more widely used in Germany some 
years later. 

Therapeutics. — Sozoiodol has been found of value as an antiseptic 
and disinfectant in the treatment of wounds which are in an unhealthy 
state, and for acute stomatitis and pharyngeal catarrh it may be em- 
ployed locally in the form of a 5 per cent, watery solution. It has 
also been found useful in acute 'purulent conjunctivitis and in oph- 
thalmia neonatorum, in the proportion of 2 parts of sozoiodol to 30 
parts of water. In urethritis of a specific type the preparation known 
as zinc-sozoiodol may be employed in a 2 per cent, solution with 
advantage, and this compound is also of value in mild and malignant 
vaginitis if preceded by pyroligneous acetic acid or nitrate of silver, 
applied by means of a speculum. 

In the treatment of gynecological cases, particularly in catarrh of 
the cervix uteri, Nitschman uses sozoiodol in the form of a powder 
applied by means of a tampon with good results, and it would seem 
to be worthy of trial in many other states of the mucous membranes 
than those just named. 

SPIGELIA. 

Spigelia, U. S., Pinkroot, is the root and rhizome of Spigelia mari- 
landica, or Carolina Pink, a plant of the Southern United States. 

Poisoning. — The symptoms of poisoning by spigelia closely resemble 
those of belladonna poisoning. 

Therapeutics. — Spigelia is one of the most efficient remedies in the 
treatment of round-worms, and is not dangerous when given with 
care. When employed for the removal of worms, the usual precaution 
should be taken in regard to the ingestion of food (see article on 
Worms), and the drug should be followed by a purge to sweep out 
the worm while it is narcotized. The purge should be one which is 
rapid in its action, such as the sulphate of magnesium. 

Administration. — The dose of spigelia in the form v>( the fluid extract 
(Fluidextr actum Spigelia*, U. S.) is 2 drachms (8.0) ; that of the un- 



SQUILL. 425 

official fluid extract of spigelia and senna (Pluidextractum Spigelian 
et Senna) is J to 1 drachm (2.0-4.0) for a child of two years of 
age; \ ounce (16.0) is the dose for an adult. The addition of fluid 
extract of senna makes the drug more efficient, and the mixture is 
generally not disliked by children It is to be remembered that this 
latter mixture is no longer official. 



SQUILL. 



Scilla', U. S. and B. P., is the sliced bulb of Urginea maritima (Scilla, 
B. P.), a plant of the countries bordering on the Mediterranean. It 
contains scillin, scillipicrin, and. scillitoxin, all of which possess poison- 
ous properties, and none of which is used in medicine alone, except, 
by few practitioners. 

Poisoning. — In poisonous ! doses squill produces vomiting, purging, 
dulness, stupor, intermittent palsy, convulsions, and death in ten to 
twenty hours. These symptoms are preceded by a marked fall in tem- 
perature. The urine is suppressed or bloody and acute nephritis is 
produced. Gastro-enteritis may be marked. 

Therapeutics. — Squill is largely used as a stimulant or irritant diuretic, 
not to affect the renal epithelium directly and promote secretion, but 
rather to tone up and excite to normal effort a kidney depressed 
by disease, as in chronic Brighfs disease or renal congestion from 
cardiac trouble. In cardiac dropsy, combined with digitalis squill is 
a standard and much-used remedy, and is undoubtedly of value in 
aiding in the absorption of effusions in the pericardium, pleura, and 
abdomen. Squill is usually given in dropsy, in pill form, as follows: 

I$— Pulv. scillse gr. x (0.60). 

Pulv. digital, fol. 3j (1.3).— M. 

Ft. in pil. No. x. 

S. — One t. i. d. after meals. 

The employment of squill in bronchitis, although largely resorted 
to, is not to be commended, since its irritant action on the kidneys 
and stomach may cause trouble. The period for its administration is 
in the beginning of the second stage, when secretion is scanty or so 
excessive as to need proper stimulation of the mucous membranes 
to bring on a healthy action. At one time Coxe's Hive Syrup was 
largely used, either as an emetic in drachm doses every ten minutes 
until it acted, or as an expectorant in the dose of 30 minims to 1 
drachm (2.0-4.0) three times a day for an adult. As it contains 
antimony, it should be given with care. 

Administration. — The fluid extract (Fluidextr actum Scilla) is much 
used in the dose of 1 to 5 drops (0.05-0.3); the tincture (Tincturee 
Scilla, U. S. and B. P.) in the dose of 5 to 30 minims (0.3-2.0) ; 
the vinegar of squill (Acetum Scilla, U. S. and B. P.) in the dose of 
10 minims to \ drachm (0.60-2.0). The compound syrup (Syrupus 



426 DRUGS. 

ScilloB Compositus), or Coxe's Hive Syrup, is composed of the fluid 
extract of squill, fluid extract of senega, tartrate of antimony and 
potassium, precipitated phosphate of calcium, sugar, and water, and 
is given in the dose of 20 minims (1.3) as a sedative to an adult and 
1 drachm (4.0) as an emetic to a child. 

The following prescription will be found useful in bronchitis in its 
subacute stages in a child of one to five years: 

1^ — Vini ipecac foj (4.0). 

Tincturae scillse f§ij (8.0). 

Syr. tolutan f5v (20.0). 

Aquae f Sj (30.0).— M. 

S. — Teaspoonful (4.0) every three or four hours. 

The plain syrup (Syrupus Scilloe, U. S. and B. P.) is given in the 
dose of \ to 1 drachm (2.0-4.0), the honey (Oxymel Scilloe, B. P.) 
in the dose of \ to 1 drachm (2.0-4.0), and the compound pill (Pilules 
Scillce Composita, B. P.) in the dose of 5 to 10 grains (0.3-0.60). 

STARCH. 

Amylum, U. S. and B. P., is wheat starch, but good corn starch 
is frequently employed. In very fine powder starch is used as a dust- 
ing-powder in intertrigo or chafing. Its more important uses are, 
however, in the form of starch-water for carrying drugs into the 
rectum, and in the form of a poultice for cases of skin diseases where 
it is desired to remove crusts. 

Starch-water is made by adding 2 tablespoonfuls of starch to 1 
pint of water, then boiling it to a paste and diluting it by the addition 
of warm water to the consistence of syrup. Starch-water is not only 
useful as a vehicle for drugs given by the rectum, but also as a sedative 
injection in proctitis and rectal irritation. 

The starch poultice is made by boiling the starch to a pasty con- 
sistence or by adding enough boiling water to a paste made by rubbing 
cold water and starch together to produce a gelatinous mass. Thirty 
grains (2.0) of boric acid to the ounce (30.0) render it antiseptic. 

STILLINGIA. 

Stillingia, U. S., Queen's Root, is the root of Stillingia sylvatica, 
a plant of the United States, the active principle of which is stillingin. 

Physiological Action. — There can be no doubt that this drug acts 
in two ways: first, by its immediate effects on the system, and, second, 
by its more slowly-shown alterative influences. In overdose it causes 
bilious purging, increased heart-action, and active secretion from the 
bronchial mucous membrane. 

Therapeutics. — Stillingia is highly recommended in habitual con- 
stipation, as it increases intestinal secretion, and it is even said to act 



STRONTIUM. 427 

as a specific in hemorrhoids dependent largely for their existence upon 
hepatic engorgement and intestinal atony. 

Bartholow recommended the following prescription under these cir- 
cumstances : 

1^— Extract, stillmgiae fluid fov (20.0). 

Tincturae belladonnse, 
Tincturae nucis vomicae, 

Tincturae physostigmatis . . . . aa f 3j (4.0). — M. 
S. — 20 drops (1.3) in water t. i. d. before meals. 

Tincture of aloes may also be added to this prescription if constipa- 
tion is present. In syphilis of a severe type stillingia should be used 
as an aid to other drugs. 

In pasty-looking, white, "putty-faced" children, who are anaemic 
or strumous, and who never have any appetite, or are subject to 
middle-ear trouble and general debility, stillingia is of value. Under 
these circumstances it should be used for some time. 

The only official preparation is the fluid extract (Fluidextr actum 
Stillingia, U. S.), which should always be made of the fresh root, 
the dose of which is 10 to 60 minims (0.60-4.0). 



STRAMONIUM. 

Jamestown Weed, or Datura Stramonium, is official in the form of 
the leaves (Stramonium, U. S. ; Stramonii Folia, B. P.). It contains 
an alkaloid, known as daturine, which is physiologically identical 
with atropine. 

Physiological Action. — (See Belladonna.) 

Therapeutics. — The uses of stramonium are identical with those of 
belladonna. 

Administration. — The extract (Extr actum Stramonii, U. S. and B. P.) 
is used in the dose of £ to i grain (0.01-0.03), the fluid extract 
(Fluidextractum Stramonii, U. S.) in the dose of 1 to 5 minims 
(0.05-0.30), and the tincture (Tinctura Stramonii, U. S. and B. P.) 
in the dose of 5 to 30 minims (0.3-2.0). The ointment (Unguentum 
Stramonii) is also used for the same purposes as is belladonna oint- 
ment. The dose of daturine is ^ to -fa grain (0.0005-0.0008). 



STRONTIUM. 

This metal has been introduced into medicine in the form of the 
bromide (Strontii Bromidum, U. S.), iodide (Strontii Iodidum, U. S.), 
salicylate (Strontii Salicylas, U. S.), the lactate and phosphate, 
largely through the studies of Laborde, See, Paul, and others. 
Bromide of strontium is used for precisely the same effects as are 
the other bromides, but it is claimed that, as the strontium has 



428 DRUGS, 

a distinct nutritive influence over the system, the disadvantages of 
the potassium salt are avoided. The dose of bromide of strontium 
is from 30 to 60 grains (2.0-4.0). In addition to the ordinary effect 
of bromides, See found the bromide of strontium to be useful in 
overcoming attacks of gastric indigestion associated with pain in the 
stomach and hyperacidity; and the author has confirmed this state- 
ment. The lactate of strontium seems to be indicated chiefly in 
cases of albuminuria due to renal atony. It does not increase, urinary 
flow, and is contraindicated in the presence of the uraemia and the 
high fever of acute parenchymatous nephritis. In chronic parenchy- 
matous nephritis, such as is due to rheumatism or gout, it is of value. 
Unfortunately, as soon as the lactate of strontium is withdrawn the 
albuminuria is apt to recur. The writer has often been much disap- 
pointed in the use of the lactate of strontium in albuminuria, but 
others of wide experience seem to regard it as constant in producing 
good results. The dose of the lactate of strontium is 60 to 100 
grains (4.0^6.6) a day. 

The salicylate of strontium is a valuable preparation, because it is 
not so disagreeable to the taste as the corresponding salt of sodium; 
and, more important still, it is far less apt to disorder the stomach than 
salicylic acid itself or any of its other salts. The author has found it 
for these reasons very useful in acute articular rheumatism when the 
progress of the patient was delayed by the inability of his stomach 
to retain the ordinary antirheumatic remedies. The salicylate of 
strontium is best given in capsule or cachet, and should always be 
followed by a draught of milk or water to prevent its coming in con- 
tact with the stomach in too concentrated form. The dose is, for all 
practical purposes, identical with that of the salicylate of sodium. 

Strontium possesses no toxic power whatever, and overdoses are not 
followed by unpleasant consequences. If the strontium is contami- 
nated by barium, serious effects are produced. 

STROPHANTHUS. 

Strophanthus, U. S., Strophanthi Semina, B. P., is an African plant 
(Strophanthus Kombi), from the seed of which the natives make 
kombe arrow-poison. There are many varieties of Strophanthus. 
The active principle is strophanthin, from which is derived strophan- 
thidin. It has been claimed that strophanthus contains a local anaes- 
thetic principle, but de Schweinitz and the author found it to be 
possessed of this power only in dogs, and not in man. 

Physiological Action. — Strophanthus acts as a stimulant to the 
heart muscle and its ganglia, but does not slow the pulse by its action 
on the vagus as does digitalis. While it raises arterial pressure by the 
increased heart action, it does not stimulate the vasomotor system to 
any extent. It is therefore useful in cases of weak heart with arterial 



SUGAR OF MILK. 429 

spasm, since it helps the heart, but does not increase its work, by 
■raising arterial tension. 

Therapeutics. — Strophanthus may be used to supplant digitalis in 
all forms of cardiac disease, but it is not its equal. 

From the cases of cardiac disease seen frequently by the writer he 
has reached the conclusion that digitalis gives relief to patients under 
the age of twelve years in a much smaller proportion of cases than it 
does in adults, and that, though the stomach is no more frequently 
disordered, increased dyspnoea, nervous irritability, and cyanosis often 
follow its use. Strophanthus generally gives good results in this class 
of cases. On the other hand, strophanthus is better than digitalis 
in cases of weak heart with high arterial tension, as it exerts no effect 
upon the bloodvessels, as does digitalis. 

As is well known, there are a certain number of cases in which 
digitalis seems to do harm in adults, the explanation being that under 
such circumstances the ventricle is so overstimulated that the auricle 
cannot empty itself thoroughly, and becomes congested in consequence. 
Strophanthus acts exceedingly well in those instances where digitalis 
fails, and this is particularly true in children. It will relieve cardiac 
dropsy by its action on the heart, but does not possess marked diuretic 
properties. 

Untoward Effects. — Strophanthus when given in full dose frequently 
causes diarrhoea. 

Aministration. — Strophanthus is given in the form of the tincture 
(Tinctura Strophanthi, U. S. and B. P.) in the dose of 5 to 15 minims 
(0.30-1.0) three times a day. The extract of strophanthus {Extr actum 
Strophanthi) is now official in the B. P. The dose is J grain (0.015). 
Strophanthin (Strophanthinum, U. S.), a mixture of alkaloids, may be 
given hypodermicaliy in the dose of y^-g- to ^ grain (0.(004-0X012). 
Its effects when so used are said to last a week, but this statement 
can scarcely be correct. 

SUGAR. 

Saccharum, U. S. (Saccharum Purificatum, B. P.), is the refined 
juice of Saccharum ofjicinarum, or Sugar-cane, or the juice obtained 
from the Sugar-beet. It is an antiputrefactive, but not an antifer- 
mentative. Mixed with iron preparations, it prevents oxidation. As 
it is a hydrocarbon, it is a nutrient and a developer of adipose tissue, 
or, in other words, is a food. Its use is contraindicated in obesity, 
during the existence of fermentative changes in the stomach and 
intestine, and in diabetes mellitus. 

SUGAR OF MILK. 

Saccharum Lactis, U. S. and B. P., is derived from the whey of 
cows' milk by evaporation, in the proportion of about 5 per cent., and 



430 DRUGS. 

is then purified by re-crystallization. It has little sweetening power com- 
pared to cane-sugar and possesses a peculiar insipid taste. It is, how- 
ever, less apt to ferment and is better for infants than is cane-sugar. 

Milk-sugar is largely used in triturations, because by its hardness 
it aids in the subdivision of the medicament. It is also used to increase 
the bulk of small powders where such drugs as podophyllin and calo- 
mel are prescribed. 

Recent studies, both scientific and clinical, have shown lactose to 
be possessed of great diuretic power when given in full doses. 
The advantage claimed for lactose as a diuretic is its direct action on 
the kidney and the slight effect exercised upon the rest of the organism. 
It is, therefore, in renal dropsy or renal inactivity that this substance 
is particularly indicated. The dose of lactose in cases of dropsy 
should be as great as from 2 to 4 drachms (8.0-16.0), given daily, 
dissolved in a quart (960 c.c.) of water. It has been found that the 
lactose acts best in those cases in which there is no albuminuria. 
These recent studies are of interest in view of the well-known clinical 
fact that the addition of lactose to the milk of bottle-fed babies always 
causes profuse diuresis. 



SULPHONAL. 

Sulphonmethanum, U. S., Sulphonalum, B. P., is a synthetically 
prepared substance first manufactured in Germany by Baumann, and 
possesses the chemical name of diethyl-sulphon-dimethyl-methane. It 
is a colorless, odorless, solid substance, soluble in 360 parts of cold 
and 15 parts of boiling water, and in 47 parts of alcohol and ether. 
The drug is not affected by any of the ordinary acids, and is very 
stable. 

Physiological Action. — In medicinal doses the effect of sulphonal 
upon the lower nervous system is practically nil. The dominant effect 
is on the brain. The drug is completely changed during its passage 
through the body. On the circulation the drug has but little effect; 
upon the respiration it acts as a depressant when given in full doses. 

Therapeutics. — Sulphonal finds its place in medicine as a somni- 
facient or hypnotic, valuable when junctional nervous insomnia is 
present, useless where advanced disease, such as cardiac trouble, is 
responsible for the wakefulness. In insanity it often produces sleep, 
and is of great service in the various mental disturbances character- 
ized by lack of sleep and often affecting persons of unsound mind. 
Sulphonal may be defined very briefly by any one who has largely 
used it or watched the reports made of its progress. This definition 
is that the drug does possess sleep-producing power of moderate 
amount — not equal to chloral, but greater than that of paraldehyde — 
and that it will sometimes succeed where the other hypnotics fail. 
It has the great advantage of not being a depressant to the heart. 



SULPHUR. 431 

Administration. — Sulphonal being virtually insoluble in cold water, 
may be given in large capsules or in mucilage of acacia, so as to be 
held in suspension until swallowed. The insolubility and bulki- 
ness of the drug render its use difficult. It is best given in hot water 
(about 6 ounces), as suggested by Stewart. This makes a solution, 
and as soon as the liquid is cool enough to be swallowed it should be 
taken before precipitation occurs as the result of cooling. Sulphonal 
should be used several hours — say two or three — before the patient 
retires. If taken late at night, the patient frequently fails to 
sleep until the morning hours, and is heavy and drowsy all the next 
day. This difficulty is partly avoided by the use of a hot solution, 
but even then is apt to arise. The dose is 20 to 40 grains (1.3-2.6). 
It is wise not to use sulphonal continuously for more than a few days. 

Untoward Effects. — When sulphonal is taken in full dose for long 
periods of time, great sleepiness and weariness, with an unsteady 
gait, develop, which may go on to paralysis of the lower extremities 
if the use of the drug is persisted in. In some cases the paralysis is 
progressive, and in others hyperesthesia and abnormal sensations 
develop. In all such cases there is great disturbance of digestion 
with scanty secretion of urine, which contains an unusual substance, 
giving this secretion the color of port wine (hrematoporphyrinuria). 
This is partly due to a cumulative effect of the drug. Sulphonal often 
produces mental heaviness and a staggering gait the day after it is 
taken. This can to some extent be avoided by giving a dose of some 
laxative when the drug is taken, so that the bowels will be moved 
thoroughly the next morning. There are a number of cases of death 
on record from acute and chronic poisoning by sulphonal. In both 
classes of cases the death was by respiratory failure preceded by pro- 
found unconsciousness. As much as 120 grains (8.0) have been taken, 
however, without ill effect, and Neisser has reported a case which 
recovered after 1400 grains had been taken. Probably but a small 
amount of this dose was actually absorbed. In cases of subacute or 
chronic poisoning the prognosis is unfavorable if the symptoms are 
well developed. 

SULPHUR. 

Sulphur is a non-metallic element official in three forms in the 
U. S. P. — namely, as Sulphur Sublimatum, U. S. and B. P., or sub- 
limed or flowers of sulphur; Sulphur Prcecipitatum, U. S. and B. P., 
or precipitated sulphur; and Sulphur Lotum, U. S., or washed sulphur. 

Much confusion exists among students as to the differences between 
these various forms of sulphur. Sulphur itself is an element which 
is prepared for medicinal uses by being heated and sublimed (Sulphur 
Sublimatum), or flowers of sulphur. Sulphur lotum, or washed sul- 
phur, is prepared in order to get rid of sulphuric acid and other con- 
taminating substances, and is made from sublimed sulphur. Sulphur 



432 DRUGS. 

prsecipitatum is also made from sublimed sulphur, and is more bland 
and minutely subdivided. Some believe it differs from sublimed 
sulphur in its therapeutic properties by reason of a small amount of 
water supposed to be present. It is sometimes called milk of sulphur. 
When sulphur is prescribed for internal use the sublimed sulphur is 
generally designated. 

Physiological Action. — Sulphur has little physiological influence 
over the general system. When taken internally it causes a soft, 
mushy stool of a yellow color with a strong odor of hydrogen sul- 
phide. The drug acts particularly on the skin and mucous mem- 
branes as a gentle alterative. The juices of the intestines break up 
some of it into sulphuretted hydrogen and sulphides. 

Therapeutics. — Sulphur is used as a mild laxative, never as a purge. 
In stricture of the bowel the soft stools produced by it will often slip 
by the obstruction, and it is worthy of note that sulphur will some- 
times overcome constipation when nothing else will give relief. It is 
particularly valuable in the treatment of constipation where there 
are hemorrhoids, and in chronic rheumatism and sciatica it is thought 
by some to effect a cure. 

Sulphur is of service in the treatment of chronic bronchial 
affections, but for some curious reason its use has become almost obso- 
lete. The so-called Bergeon's method of treating phthisis by rectal 
injections of carbonic acid gas with sulphuretted hydrogen was 
simply a revival of a custom of our great-grandfathers, who often used 
sulphur-waters by the mouth in the treatment of catarrhs or other 
disorders of mucous membranes. Bergeon took the trouble to go to 
the rectum to accomplish what was done two hundred years ago by 
the mouth, and the only novel part of his method was his unusual way 
of using the remedy. Graves recommended 5 to 10 grains (0.30-0.60) of 
sulphur three times a day wherever bronchial secretion was excessive, 
and found that it rid the lungs of mucus and relieved the cough. 

The external use of sulphur is very much more important than its 
internal use, in so far as regards affections of the skin. Of itself, 
the drug exercises little effect over the cuticle when used in powdered 
form, but combination with an ointment makes it at once active. Even 
irritations of the skin may ensue from its constant use in large amount. 

In scabies, or itch, sulphur ointment (Unguentum Sulphuris, U. S. 
and B. P.) is the best remedy we have. The female parasite burrows 
under the epiderm and deposits the ova as she moves about, while the 
male does not burrow, but stays on the surface. The ointment will 
kill him, as he is readily attacked, but the female is protected by her 
burrowing propensities. To get at her and the ova the burrows must 
be opened, and this may be accomplished by a thorough soaking of 
the body with soap and water, thereby softening the epiderm covering 
the parasite, which can then readily be removed by rubbing the patient 
with a rough towel. The towel should be boiled at once to prevent 



PLATE III. 

J 





• Stomach Corroded by a Poisonous Dose of Sulphuric Acid 

(Kast and Rumpler.) 



SULPHURIC ACID. 433 

its conveying the parasite to others. The ointment, if now applied, 
relieves the patient almost at once. It is important that the skin be 
well softened and rubbed, in order to keep open every burrow. The 
ointment should be allowed to remain on the part all night and be 
used for three or four nights consecutively. 

Young women often suffer from acne, particularly about the men- 
strual epoch, the skin also becoming at this time sallow and muddy. 
The following ointment is one which is very successful in promoting 
a cure: 

1$ — Sulphuris prsecipitat 3j (4.0). 

Lanolini §j (30.0).— M. 

S. — Apply once or twice daily. 

Administration. — Sulphur is given in the dose of 10 to 20 grains 
(0.60-1.3) three times a day as an alterative, and from 1 to 2 drachms 
(4.0-8.0) at night as a laxative, with a little molasses to form a paste. 

A confection (Confectio Sulphuris) is official in the B. P., dose 10 
grains to 2 drachms (0.60-8.0), as is also Trochiscus Sulphuris. 

Sulphide of Calcium. 

(See Calcium, Calx, and Sulphides.) 

SULPHURIC ACID. 

Acidum Sulphuricum, U. S. and B. P., Sulphuric Acid, or Oil of 
Vitriol, is a powerful irritant and escharotic, rapidly dehydrating 
and carbonizing the tissues, causing them to become black. It is the 
most astringent of the medicinal mineral acids, and when absorbed 
it unites with bases to form sulphates, and is so eliminated by the 
kidneys, the lower bowel, and the skin. It coagulates albumin. 

Poisoning. — The symptoms produced by poisonous doses are those 
of a gastro-intestinal inflammation of the most severe type, or the 
patient may drop to the floor almost at once, owing to collapse depend- 
ent upon perforation of the walls of the oesophagus or stomach by 
the acid and its consequent escape into the peritoneal cavity. If the 
patient lives to the fourth day, the parotid glands may become swollen 
as the result of stenosis of the salivary ducts of Steno, and violent 
inflammation of the kidneys may appear from the passage of the 
drug through these organs in the process of elimination. If partial 
recovery takes place, the patient often dies from inanition due to the 
formation of strictures in the alimentary canal or to destruction of 
the peptic tubules. The stain about the mouth is black, and if any 
of the acid is spilt on the clothing the characteristic burn is to be 
seen. 

The treatment consists in the use of alkalies, such as chalk, mag- 
nesia, whitewash off walls, and soap. Opium and oils are to be given 
to allay irritation, and external heat is to be applied. 

28 



434 DRUGS. 

Therapeutics. — Sulphuric acid is sometimes employed as a caustic 
to venereal sores, warts, and slowly-healing ulcers, but is most com- 
monly used internally, as it fulfils several pressing indications. As 
a remedy for serous diarrhea, particularly if combined with some 
vegetable astringent, it is unsurpassed, and its use in cholera deserves 
great attention. (See Diarrhoea.) In the Philadelphia Hospital dur- 
ing an epidemic of cholera some years since every case which received 
sulphuric acid improved or failed to be attacked, whereas those who 
did not receive it were either very ill or died. 

The proper way to use the drug as a prophylactic during cholera 
epidemics is in the form of "sulphuric-acid lemonade," made so that 
each wineglassful of water contains 5 drops (0.30) of the aromatic 
sulphuric acid. The same solution may be used in acute lead poisoning 
in order to form an insoluble sulphate of lead, and may be taken by 
artisans exposed to chronic lead poisoning as a prophylactic for the 
same purpose. 

Sulphuric acid combined with belladonna or morphine is often 
useful in the night-sweats of phthisis. 

Administration. — The dose of the dilute acid (Acidum Sulphuricum 
Dilutum, U. S. and B. P.) is 5 to 20 minims (0.30-1.3), and of the 
aromatic acid (Acidum Sulphuricum Aromaticum, U. S. and B. P.) 
5 to 20 minims (0.30-1.3). The latter is the best preparation for 
general use. It contains ginger and oil of cinnamon. Both prepara- 
tions should be thoroughly diluted before they are administered. 



SUMBUL. 

Sumbul, U. S., is a root of undetermined origin. The dose of the 
root (Sumbul Radix, B. P.) is 10 to 40 grains (0.60-2.6). On the 
nervous system sumbul acts as an efficient nerve tonic, and was largely 
employed by Goodell in cases of nervous exhaustion and in the unrest 
of nervous females. It is official in the fluid extract (Fluidextractum 
Sumbul, U. S.), dose 5 to 20 minims (0.30-1.30), and the extract 
(Exlractum Sumbul, U. S.), dose 1 to 5 grains (0.06-0.30). The 
tincture (Tinctura Sumbul, dose 1 to 4 drachms (4.0-16.0) is official 
in the B. P. Goodell used the following formula: 

R — Extract sumbul gr. xx (1.3). 

Ferri sulph gr. xx (1.3). 

Asafceditse gr. x (0.60). 

Acid, arsenosi gr J (0.03). — M. 

Ft. in pil. No. xx. 

S. — One t. i. d. after meal. 

To be of any value the drug must be fresh, and care must be taken 
that the crude drug from which it is made is a good sample. 



SUPRARENAL GLAND AND ADRENALIN. 435 



SUPRARENAL GLAND AND ADRENALIN. 

The suprarenal gland, or its active principle, has become within 
the last few years one of our most valued remedies. Its chief use in 
medicine depends upon its extraordinary power of producing contrac- 
tion of small bloodvessels and capillaries with which it is brought in 
contact. It also exercises a marked constricting effect on the blood- 
vessels of the general arterial system when given intravenously. 

Fig. 56. 




TX 



^mmm^ 



Showing the rise of arterial pressure produced by the injection of 0.00004 of adrenalin into the 

vein of a dog. 

The medullary portion of the glands is chiefly concerned with the 
elaboration of the active physiological principle, which has been 
isolated by a Japanese chemist, Takamine, and called adrenalin. 
Adrenalin occurs in tiny, almost microscopic, white crystals of various 
forms, which are soluble in water after slight acidulation with hydro- 
chloric acid. 

Physiological Action. — When locally applied to mucous membranes 
extract of this gland, or adrenalin, produces great blanching by reason 
of its powerful constriction of the capillaries of the part. So great 
is this constriction that the superficial tissues are practically blood- 
less while its influence lasts. This local effect is due to stimulation 
of the muscular fibres in the bloodvessel walls. Its use is not followed 
by the great relaxation and congestion seen after the local application 
of cocaine to a mucous membrane. Given internally, it slows the 
pulse by stimulation of the vagus nerves and by the increased arterial 
pressure due to the contraction of the muscular coats of the blood- 
vessels, which causes an increase in the resistance to the free flow of 
blood. This effect is due to the action of the drug on the vessel walls 
and not to a centric vasomotor influence. Upon the venous system 
its effects may be ignored. It also increases the force of the systole of 
the heart by stimulating its muscular fibres. 

Therapeutics. — Because of its extraordinary power in constricting 
bloodvessels of small calibre adrenalin is a remedy in all forms of 



436 DRUGS. 

hemorrhage from such vessels, particularly if it can be locally applied. 
Thus it can be employed in epistaxis, menorrhagia, metrorrhagia, and 
for the purpose of controlling hemorrhage in operations on the nose, 
throat, ear, or larynx. It can also be employed to relieve the engorge- 
ment of the nasal mucous membrane in cases of coryza and hay fever, 
and in trachoma and conjunctivitis. 

When given intravenously adrenalin is employed in cases of cardiac 
and vasomotor failure or lack of vascular tone, and to overcome the 
dangerous vascular relaxation sometimes occurring in chloroformi- 
zation. 

It has also proved itself a valuable agent in controlling surgical 
shock. Under these circumstances the vasomotor centre is depressed 
or paralyzed and death ensues because of the vascular relaxation. 
The use of strychnine for the purpose of stimulating the vessels through 
the vasomotor centre is often useless because it is too depressed to 
respond. Under these conditions the intravenous injection of adrena- 
lin acts directly upon the muscular fibres in the vessel walls and raises 
blood pressure so that life is saved. When adrenalin is used in this 
way the ordinary 1 : 1000 solution in which it appears on the market 
should be added to the extent of 1 to 2 drachms (4.0-8.0) to a pint of 
normal saline solution and given intravenously or by hypodermoclysis. 
Strong solutions should not be used hypodermically because they 
cause ischaemia of the part injected, and this in turn permits germs 
to grow and so a slough may ensue. 

Administration. — Suprarenal gland may be given in desiccated form 
(Glandulw Suprarenales Sicca;, U. S.) in the dose of 3 to 10 grains 
(0.20-0.60), or as an extract of the gland, in the dose of 3 to 5 grains 
(0.20-0.30) three times a day or oftener. By far the best form in 
which to use it is adrenalin chloride in normal salt solution, 1 : 10,000 
to 1:1000. Adrenalin may be given internally in tablet or capsule, 
but if it is being used in a case of shock its action by this method is 
too slow and the gastric juice probably diminishes or destroys its 
effects. When used locally it is employed by wetting a pledget of 
cotton with the solution named and then pressing it lightly against 
the part which it is desired to affect. Blanching comes on in a few 
moments. A solution of 1 : 10,000 or stronger may also be brought 
in contact with the part by means of an atomizer. 

SWEET SPIRIT OF NITRE. 

Sweet Spirit of Nitre (Spiritus Mtheris Nitrosi, U. S. and B. P.), 
or Spirit of Nitrous Ether, is a mixture of alcohol, water, and ethyl 
nitrite. Spirit of Nitrous Ether should contain 4 per cent, of 
ethyl nitrite. It is upon this last constituent that most of its value 
as a remedial agent depends. The drug when sold by pharmacists 
or others who are not careful to keep fresh preparations is no better 
than alcohol and water alone, since the ethyl nitrate readily escapes, 



SWEET SPIRIT OF NITRE. 437 

and deterioration at once takes place. Until recently the profession 
have had no ready means of protecting themselves from such poor 
preparations, but at present we know that all that is necessary to dis- 
cover this absence is to add a grain or two of antipyrin to a \ ounce or 
less of the spirit. If the ethyl nitrite be present, a purple color fol- 
lowed by a green precipitate will be formed. This green precipitate is 
iso-nitroso-antipyrin, which is not in the least poisonous. 

Physiological Action. — Sweet spirit of nitre is a sedative to the cir- 
culatory and nervous system, as are all the nitrites (see Nitrite of Amyl), 
and a diaphoretic and diuretic, according to the manner in which it 
is administered. If given in very full doses, it rapidly produces the 
cyanosis characteristic of the full effects of any one of the nitrites. 
(See Amyl Nitrite.) 

Therapeutics. — There is probably no drug so widely employed by 
the laity as a household remedy which is so potent for good, and yet 
so harmless, if wrongly used, as is this one. 

Physicians often place less reliance upon it than it deserves, and 
in nearly every instance where it fails it is either not indicated or the 
nitrous ether has escaped and left it powerless. 

In incontinence of urine in children the combination which follows 

is very useful in certain cases. (See also Incontinence of Urine, Part 

IV.) In these instances the urine will be found high-colored and 

concentrated, and therefore capable of irritating the bladder and 

genito-urinary tract: 

R— Potassii citratis 5j to 5ij (4.0-8.0). 

Spt. aetheris nitrosi f§ss (16.0). 

Aquae destill q. s. ad fgiv (120.0).— M. 

S. — Dessertspoonful (8.0) every five hours until the urine becomes clear. 
As soon as the urine is clear and neutral, belladonna may be used, 
the citrate of potassium and spirit of nitre being continued or not 
as the case demands. When the spinal centres are depressed and there 
is general atony of the system, it may be well to substitute the fol- 
lowing pill for the belladonna: 

& — Arseni trioxidi gr. 4; (0.015). 

Extract, nucis vomicae gr. ij (0.12). 

Quininae Sulphatis gr. xx (1.3). — M. 

Ft. in pil. No. xx. 

S. — One pill t. i. d. after meals. 

The diuretic action of sweet spirit of nitre is best obtained by using 
the drug in ice-cold water and keeping the patient lightly covered 
and cool. On the other hand, if a diaphoretic influence is desired, 
it may be given simultaneously with warm lemonade, and the patient 
should be well blanketed. This last action of sweet spirit of nitre 
has made it a remedy of common use in treating acute colds in adults 
and children, and in diminishing the fever of these conditions in the 
latter class as well. 

Sweet spirit of nitre is a distinct antispasmodic, and can be well 
employed where slight nervous excitement accompanies fevers or in 
other states associated with nervous irritation in infancy. 



438 DRUGS. 

The dose for an adult is from 20 minims to 1 drachm (1.3-4.0), 
and for a child of one year 5 to 10 minims (0.30-0.60). It should 
always be given in cool water to the latter class of patients. 

TAMARINDS. 

Tamarindus, U. S. and B. P., is the preserved pulp of Tamarindus 
indica, sl tree of the West Indies. 

The taste is a peculiar mixture of bitter and sweet. As a laxative 
it exerts little power over that of any ordinary fruits, such as apples, 
but it enters into the confection of senna (Confectio Sennas, U. S. and 
B. P.). Patients often find tamarinds a very agreeable laxative when 
they are taken before going to bed or eaten as a confection after meals. 

TANNIC ACID. 

Tannic Acid (Acidum Tannicum, U. S. and B. P.) when pure is 
an uncrystallizable, white or yellowish-white powder, without bitter 
taste and very soluble in water and glycerin. It is not soluble in alcohol 
or ether. It is the chief active principle of vegetable astringents, and 
occupies the relative position of an alkaloid to a crude drug, so far as 
the active portion of these vegetable astringents is concerned. Tannic 
acid is derived from nut-gall. 

Physiological Action. — Tannic acid when brought in contact with 
any of the tissues of the body constringes them and decreases their 
vascularity for a time, by causing contraction of their bloodvessels. 
For these reasons it stops secretion and condenses parts of the body 
which are relaxed and feeble. Mixed with blood, it forms a clot with 
great rapidity through coagulation of the albumin. Tannic acid is 
absorbed as gallic acid and eliminated as such, only acting as tannic 
acid before absorption. This is important to remember, since we 
learn from this that tannic acid is to be used to check hemorrhage 
only where the drug can be brought in direct contact with the bleed- 
ing point. If a hemorrhage is to be reached through the circulation, 
as in renal bleeding, gallic acid is to be given, as it is absorbed at 
once without change. 

Therapeutics. — Tannic acid is used in medicine to control hemor- 
rhage, and to act as an astringent to relaxed tissues, as in diarrhoea 
of the atonic or serous type, or in localized or general sweating. It 
is also of service for the purposes of toughening mucous membranes 
or parts of the skin which are exposed to much rubbing, as in the 
case of the nipples of a primipara, or where the feet become macer- 
ated and sore or sweat profusely on exercise being taken. In the 
treatment of haemoptysis tannic acid may be dissolved in water in the 
proportion of 5 to 10 grains (0.30-0.60) to the ounce (30.0) and used 
in a fine spray delivered from an atomizer. Glycerite of tannin is 
made by adding 2 ounces (60.0) of tannic acid to a \ pint (240 c.c.) of 
glycerin, and mixing at a gentle heat until solution occurs. It is use- 
ful as an application to indolent ulcers and depressed mucous mem- 



TAB. 439 

branes, as after an attack of stomatitis. In hemorrhoids of the bleed- 
ing type tannic-acid suppositories are often very useful, and cotton 
saturated with tannic-acid solution is often used as a packing in 
vaginal leucorrhcea. 

Administration. — The dose of tannic acid is 2 to 10 grains (0.12- 
0.60), best given in pill. The official preparations are — the troches 
(Trochisci Acidi Tannici, U. S.), each containing 1 grain of tannin 
the Glyceritum Acidi Tannici, U. S.; Collodium Stypticum, U. S. 
and an ointment (Unguentum Acidi Tannici, U. S.). The B. P 
preparations are — Glyceritum Acidi Tannici; Suppositoria Acidi 
Tannici, each containing 3 grains (0.20) ; and Trochisci Acidi Tan- 
nici, of which each contains h grain (0.03) of the acid. 



TANSY. - 

Tansy (Tanacetum). The leaves and tops of Tanacetum vidgare 
yield a* volatile oil (Oleum Tanaceti) which possesses emmenagogue 
powers and has been largely used as a uterine stimulant. It is also 
used as an anthelmintic. 

In poisonous dose it causes epileptiform convulsions in some cases, 
and deep coma, with death from respiratory failure. 

The dose of the oil as an emmenagogue is 1 to 3 drops (0.05-0.20). 

In domestic medicine tansy tea, made by adding 1 ounce (30.0) of 
the leaves or tops to. 1 pint (480) of water, and given in the dose 
of 1 to 2 ounces (30.0-60.0), is largely employed as a remedy for 
amenorrhea. 

TAR. 

(See p. 392.) 

Under the name of Pix Liquida, U. S. and B. P., or Tar, we have an 
empyreumatic oleoresin obtained by destructive distillation from Pinus 
palustris (Sylvestris, B. P.) and other varieties of pine. It is a thick, 
dark oil, slightly soluble in water and soluble in alcohol, oils, and solu- 
tions of potassa and soda. By distillation of tar we obtain oil of tar 
(Oleum Picis Liquids, U. S.), which is sometimes used for bronchitis by 
inhalation from an atomizer, but is not a particularly useful applica- 
tion. It should be diluted with some other oil or with fluid cosmoline. 
Tar itself is used in subacute and chronic bronchitis in 2-grain (0.12) pills, 
and as a remedy for gastro-intestinal catarrh. Externally, it is used in 
psoriasis and other skin diseases needing stimulation. For the relief 
of obstinate diarrhea Wood has highly recommended a mixture of tar 
made as follows : Add a pint of tar to a gallon of lime-water, and allow 
this solution to stand one week, stirring it every few hours. Decant 
the clear liquid and percolate it through powdered wild-cherry bark, 
allowing 1 ounce of the bark to be present for each pint passed through 
it. The dose is a wineglassful (30.0). 



440 DRUGS. 

In chronic bronchitis tar-water is largely used, as a popular remedy, 
in Europe and England. Tar-water is made by shaking 1 part of 
tar with 4 parts of water several times during twenty-four hours, 
decanting, and filtering. The dose is from 1 to 2 pints (J-l litre) 
a day as a drink. It at first increases the expectoration, but finally 
decreases it. 

Syrup of Tar (Syrupus Picis Liquidce, U. S.) is simply sweetened 
tar-water. 

In skin diseases of the dry, scaly sort, such as psoriasis, tar oint- 
ment (Unguentum Picis Liquids, U. S. and B. P.) is very useful if 
frequently applied, or the following may be used: 

]$ — Sulphur, prsecipitat., 

Picis liquidse aa 3vj (24.0). 

Saponis viridis, 

Adipis aa §ij (60.0). 

Pulv. cretse 3iv (16.0J. 

If the skin is tender, this prescription should be diluted with lard. 
Sometimes children will suffer from a persistent dry chronic eczema 
which resists all treatment; the following may then be employed with 
advantage : 

IV- Picis liquid 3ss (2.0). 

Sulphur, prsecip 3ss (2.0). 

Unguent, zinc, oxidi . §j (30.0). 

S. — Apply night and morning. 

Tar should not be used on the face, as it will stain the skin. 

Wine of Tar (Vinum Picis) is made by adding together tar 1 pint, 
glycerin, white wine, and honey, of each \ a pint, dilute acetic acid 
1 ounce, and 3 parts of boiling water, and shaking constantly at a 
temperature of 160° F. for several hours. This mixture is then set 
aside for some days and repeatedly filtered or strained through muslin. 
The dose is 1 to 4 ounces (30.0-120.0). It may be used instead of 
tar-water or tar-syrup. 



TARAXACUM. 

Taraxacum (Taraxaci Radix, B. P.), Dandelion, is a very old 
remedy for hepatic torpor and the dyspepsia resulting therefrom. 
It should be prepared from the fresh leaves or roots, as the dried 
plant is inert. From disregard of this fact much disappointment 
has arisen. Owing to its being bitter it acts as a tonic. The extract 
(Extractum Taraxaci, U. S. and B. P.), dose 5 to 30 grains (0.30- 
2.0), and the fluid extract (Fluidextractum Taraxaci, U. S.; Liquidum, 
B. P.), dose 1 to 3 drachms (4.0-12.0), are the only official prepara- 
tions. Succus Taraxaci, B. P., is given in the dose of 1 to 2 drachms 
(4.0-8.0). 






TEBPINE HYDRATE. 441 



TARTARIC ACID. 



Acidum Tartaricum, U. S. and B. P., is derived from crude potas- 
sium bitartrate, and is much less powerful than acetic acid, but capable 
of producing very severe gastro-enteritis if taken in overdose and in 
concentrated form. It is rarely used alone, and is most commonly 
employed to act upon sodium or potassium bicarbonate to form effer- 
vescent drinks. (See Seidlitz Powder and Effervescing Draughts.) 
The dose is 5 to 20 grains (0.30-1.3). 

When tartaric acid is taken in poisonous dose, lime-water, alkalies, 
and magnesia are the antidotes, and opium is to be given to allay 
irritation. If necessary, emetics are to be used. 

TEREBENE. 

Terebenum, U. S. and B. P., is a clear, colorless liquid, insoluble 
in water, having a peculiar odor like that of new pine sawdust, and 
is made by the action of sulphuric acid upon oil of turpentine, which 
is then distilled at about 160° F. 

Therapeutics. — Terebene is a useful stimulating expectorant, in 
the late stages of acute or in chronic bronchitis to liquefy and get 
rid of the mucus which is clogging the bronchial tubes. The drug 
may be given by way of the stomach or by inhalation. A useful 
mixture in the later stages of bronchitis when the mucus is very thick 
and tenacious is one composed of equal parts of terebene, iodide of 
ethyl, and chloroform, placed on a sponge and held some two or three 
inches from the face. It has also been employed in genito-urinary 
inflammations of a subacute or chronic form in place of oil of sandal- 
wood or copaiba as a stimulant. In fermentative dyspepsia it is of 
service as an antiseptic. The drug should always be given in cap- 
sule in the dose of 5 to 10 minims (0.30-0.60), or by dropping it on 
sugar in the same amount. This dose may be repeated every three 
hours. Unfortunately, terebene is very apt to irritate the stomach or 
to produce diarrhoea, and it sometimes irritates the kidneys. 

TERPINE HYDRATE. 

Terpine Hydrate (Terpini Hydras, U. S.) is prepared by a process, 
unnecessary to explain here, from a mixture of pure oil of turpentine, 
alcohol, and nitric acid. In this manner large colorless crystals, with- 
out odor and with a faint taste, are formed, and in this form the drug 
appears on the market. Terpine hydrate is soluble in 250 parts of 
cold, 32 parts of boiling water, and in 10 parts of alcohol. Of ether 
it requires 100 parts for its solution, and of chloroform 200 parts. 

Therapeutics. — Terpine hydrate is used for the purpose of increas- 
ing secretion from the pharyngeal, laryngeal, and bronchial mucous 



442 DRUGS. 

membranes, and is a useful remedy in subacute or chronic bronchitis 
to rid the tubes of mucus. The drug has also been satisfactorily 
employed in the treatment of hay fever when given in full doses. 
The remedy, while useful in only a limited number of conditions, 
certainly seems to be very useful in the diseases named. The dose as 
generally given is 2 to 3 grains (0.12-0.20), but it may be given in the 
dose of 15 to 20 grains (1.0-1 3) three times a day in hay fever. Ter- 
pine hydrate may be prescribed in pill, capsule, and in alcoholic solu- 
tion flavored with some of the aromatic waters and with the addition 
of a little syrup. Thus: 

1$ — Terpin. hydrat gr. lxxv (5.0). 

Spt. vini gallici fgij (60.0). 

Syrup, lactucarii, 

Syrup, tolutan. . . . . . . aa fgiij (90.0). — M. 

S. — 1 to 2 dessertspoonfuls (8.0-16.0) three or four times a day. 

Or we may prescribe — 

R— Terpin. hydrat gr. xl (2.60). 

Acid benzoic gr. xl (2.60). 

Codeinae gr. v (0.3). — M. 

Ft. in pil. No. xx. 

S.— 1 pill three or four times a day. 

An elixir of terpine hydrate with heroin is now widely sold, and is a 
useful preparation to act as an expectorant and allay excessive cough. 

TERPINOL. 

Terpinol is derived from terpine hydrate by boiling the latter with 
dilute mineral acids. Terpinol is an oily substance with an odor 
resembling that of hyacinths. It is almost insoluble in water, but 
dissolves readily in ether and alcohol. It is used for the same pur- 
poses as terpine hydrate, in the dose of 8 to 20 grains (0.5-1.3), in 
capsule or pilL This dose may be given twice or thrice a day. The 
drug may irritate the stomach and kidneys when given in overdose. 

THAPSIA. 

Thapsia garganica is an umbelliferous plant of Southeastern 
Europe, employed for the purpose of producing a blister. It is gen- 
erally used under these circumstances in the form of a plaster. The 
resin, obtained from the bark of the root, is the form in which it appears 
in medicine. When applied continuously it produces great irritation, 
and finally sloughs result. 

THIOCOL. 

Thiocol is derived from guaiacol, the chief active ingredient of 
creosote, and is, technically speaking, potassium guaiacol-sulphonate. 



THIOSINAMINE. 443 

It is a white fine, crystalline powder, readily soluble in water and 
in diluted alcohol, and possessing a slightly bitter, salty taste. 
Thiocol is used in medicine as a substitute for creosote and guaiacol 
in the treatment of chronic bronchitis and tuberculosis of the lungs, 
and is given in the dose of 10 to 30 grains (0.60-2.0) three times a 
day. Its advantages are its comparative tastelessness, its ready 
absorbability, and the fact that it does not irritate the stomach. It 
may be given in powder on the tongue or in capsule. 

THIOL. 

Thiol was introduced into medicine as a substitute for ichthyol, 
as the latter drug possesses the disadvantage of having a disagree- 
able odor. It is derived from brown-colored paraffin or gas oils by 
a complicated process. The product obtained is evaporated in vacuo 
to a thin extract called Thiolum Liquidum, or still further to dryness, 
or Thiolum Siccum. The liquid thiol occurs as a thin, brownish- 
black, neutral fluid, smelling somewhat like birch oil. It is slightly 
soluble in alcohol and ether, and quite soluble in water, forming 
a clear mixture, which is rendered more perfect by the addition of 
glycerin. Thiol sicca may appear in lustrous scales. It is much 
cheaper than ichthyol. 

Therapeutics. — The question which arises at once in regard to thiol 
is, whether the fact that thiol is practically an artificial ichthyol neces- 
sarily indicates that it can be used as a substitute for that substance? 
While they are both sulphur compounds, it is also true that ichthyol 
possesses extraordinary powers not met with in any other sulphur 
compound. 

Thiol has been used largely by skilful observers in diseases of the 
skin in moist eczema, scrofulosis of the skin, and in syphilides with 
asserted good results. In cases of moist eczema the thiol is used, after 
first washing the part with an antiseptic solution, by dusting it over 
the skin in the form of powder- Bidder uses compresses wet with 
thiol in 10 per cent, solution. 

While it is claimed that thiol will dissipate exudates about joints 
and elsewhere as effectively as ichthyol, sufficient evidence as to this 
point is not yet before the profession 

THIOSINAMINE. 

Thiosinamine is derived from volatile oil of horseradish, or more 
commonly from the volatile oil of mustard seed, by the addition of 
alcohol and ammonia-water and exposing it to heat. Under these 
conditions crystals of thiosinamine are deposited in prisms which are 
soluble in 2 parts of warm water, and in alcohol or ether. A solution 
of it should not redden litmus paper. 



444 DRUGS. 

When given by the mouth the dose is j to 1 grain three times a 
day. Larger doses may disorder the stomach. If this does not occur, 
as much as 3 grains may be used. Thiosinamine is used also for the 
cure of lupus in scars, and keloid, and it has been used with asserted 
success in malignant growths. In a case of keloid the drug in 10 per 
cent, solution in absolute alcohol may be injected directly into the 
part affected in the dose of 10 to 20 minims (0.60-1.3) every third or 
fourth day. The part receiving the injection usually becomes con- 
gested and swollen and dark in hue. There is often a great increase 
in the quantity of the urine, and perhaps nausea and vomiting, and 
great pain where the injection is given. In cases of lupus it may be 
injected locally or at a distant spot, and produces a reaction like that 
caused by tuberculin. Before thiosinamine is used it is necessary to 
exclude the possibility of the presence of any other old inflammatory 
focus, particularly if it be tubercular in origin, since the drug may light 
up a partly healed lesion into an active inflammatory process. 

The effect of thiosinamine upon certain abnormal tissues is extra- 
ordinary. When injected subcutaneously, or when given by the 
mouth in some instances, it causes a local reaction in those parts of 
the body in which scar tissue exists or where poorly developed patho- 
logical tissues are present. Because of this reaction the part affected 
undergoes more or less resolution and absorption takes place. After 
a hypodermic injection the effect is produced in a few hours, but 
when given by the mouth the effect is produced more slowly. The 
duration of the effect of a single dose is about five hours. Because 
of the softening which it causes in sclerotic tissues it has been used 
for the removal of scars, for the dissipation of corneal opacities, and 
relief of the deafness due to thickening of the drum or fixation of 
the aural bones. 

THYMOL. 

Thymol, U. S. and B. P., is derived from the oil of thyme and 
other volatile oils, and occurs in large crystals. It is almost insoluble 
in water, but is freely soluble in fats and oils. Thymol is irritant in 
large amount. It is antiseptic and disinfectant, and has been employed 
in typhoid fever as an intestinal antiseptic by Henry and others. 
Under these conditions it should be used in gelatin-coated pill, and a 
glass of water or milk taken to avoid the burning sensation otherwise 
produced. In the treatment of stomatitis or tenderness of the gums 
after mercurialization the following mouth- wash may be used: 

R— Thymolis - . . gr. x (0.60). 

Sodii boratis gr. xv (1.0). - 

Aquae f^ij (60.0).— M. 

S. — Place a teaspoonful (4.0) of this in % a tumblerful of water and use as a 
gargle. 

Thymol has been used for dressing wounds, but is too costly for 
general use. In summer weather it cannot be employed, because of 



THYMUS GLAND. 445 

its power of attracting flies, which make the patient's life miserable. 
The dose is J to 2 grains (0.03-0.12), in capsule or in wafer, and it is 
better to follow its use by a glass of milk to prevent the drug irritating 
the stomach. In typhoid fever as much as 30 grains (2.0) in twenty- 
four hours may be given as an intestinal antiseptic. 

If very large amounts (100 grains [7.0]) are taken in a day, poison- 
ing may result, but as much as this must be used before danger is 
present. 

Thymol Iodide. 

ThymolisIodidum,V.S.,3L compound of iodine and thymol, sometimes 
called aristol, but more correctly dithymol diiodide, was introduced 
into medicine for the purpose of acting as a substitute for iodoform. 
It should be kept in amber-colored glass vials to protect it from light. 
Its color varies from that of chocolate to reddish yellow. It is soluble 
in ether, chloroform, collodion, and in fixed and ethereal oils, but 
slightly soluble in alcohol. It is free from the unpleasant odor of 
iodoform, and it is stated to be less apt to produce poisoning by 
absorption. Much contradictory experience has accumulated as to 
its exact value, but the result of a careful examination of clinical 
reports is that in some respects it is a better drug than iodoform and 
in others not so good. 

TichhofT and Neisser state that when taken internally thymol iodide 
is incapable of causing toxaemia, but this can only be true when moder- 
ately large doses are given. Upon cocci and bacilli thymol iodide 
has less power than iodoform. In regard to the power of this drug 
in healing wounds or sores, the decision has been reached that when- 
ever secretion is free it is contraindicated, as the thymol seems to 
increase moisture. On the other hand, in those instances where in 
disease of the skin or mucous membrane an undue dryness is present 
the effect produced is often favorable. Upon lupus little effect is 
produced unless the surface is first curetted. Finely powdered thymol 
iodide has been found of marked value in the treatment of inter- 
stitial keratitis by de Schweinitz and Wallace when dusted into the 
eye each day. In an ointment of J to 1 drachm to the ounce of lard 
(2.0-4.0 : 30.0) thymol iodide may be used in psoriasis, but it is not 
so useful as is chrysarobin in this affection. 

THYMUS GLAND. 

The Thymus Gland has been used quite largely in certain diseases 
on the same principle as that governing the use of the thyroid, 
namely, that this gland possesses the function of internal secretion 
and will therefore benefit certain systemic conditions in persons in 
whom the thymus was atrophied too early in life. Others have 
used it as a substitute for the thyroid, intentionally or by mistake. 
Its chief use has been in the treatment of goitre (not exophthalmic). 



446 DRUGS. 

It does not produce any disagreeable effects as does the thyroid. 
Usually the beginning dose is J ounce (16.0) administered sev- 
eral times a week. This dose is soon increased to an ounce (30.0) 
once a week. Parke, Davis & Co. prepare thymus gland in tablets 
and capsules ready for use, and this is the best form in which to 
prescribe it. 

THYROID GLAND. 

The Thyroid Gland has been introduced into therapeutics within 
the last few years for the purpose of relieving certain disturbances of 
nutrition of which the most characteristic are myxcedema and cretin- 
ism. The results obtained from its use in these states are extraordi- 
nary, and it is to be regarded as a specific. Its use is based upon the 
fact that in cases of myxcedema the thyroid gland is usually found 
atrophied, and upon the discovery by Reverdin, Kocher, Schiff, Fuhr, 
Horsley, Crede, Zesas, and others, that extirpation of this gland pro- 
duces myxcedema or a train of symptoms practically identical with it. 
Soon after these studies had been verified, it was suggested that myxce- 
dema might be cured if it were possible to transplant part or all of the 
thyroid gland of one of the lower animals to the body of the patient 
affected, with the hope that this healthy glandular tissue would become 
vascularized and exercise its beneficent influence on the disease process. 
This method has been attempted again and again, nearly always with 
good results, which, however, have been only temporary because the 
transplanted gland has not become well vascularized and has been 
gradually absorbed. 

The objections to this method are so numerous that Murray admin- 
istered thyroid gland by the mouth and its extract hypodermically, 
with great success, and he has been followed by many others. The 
gland itself may be eaten in the dose of from one-eighth to one whole 
lobe each day, but the latter is far too large a dose in most cases. As 
it is disagreeable when taken raw, it may be very lightly fried or 
broiled or even boiled before it is eaten : but these processes diminish 
its activity; or the gland may be minced and spread on bread with 
anchovy sauce. 

If fresh thyroid cannot be had daily, a glycerin extract may be 
used. The minced gland is covered by an equal weight of pure 
glycerin, and then after soaking for twenty-four hours is placed in a 
cloth and firmly squeezed for some time to extract the glycerin laden 
with the active ingredients of the gland. This will keep for a long 
time, and may be given daily in the dose of 3 to 15 minims. 

It is, however, far better for the physician to employ the desiccated 
thyroids (Glandules Thyroidce Sicca, U. S.) in powdered form or made 
into a tablet or placed in a capsule than to use the crude preparation 
just named. A number of firms in the United States and abroad 
prepare the gland and market it in this form, and also prepare an 



THYROID GLAND. 447 

extract. Thus the extract of thyroid gland prepared by Parke, 
Davis & Co. is of such strength that 1 grain equals 10 grains of 
the crude gland or one-sixth of a desiccated thyroid. The dose of 
this is half a grain three times a day, which dose is gradually in- 
creased as the patient becomes accustomed to it. It is probably 
better, however, to use the desiccated powdered thyroid itself, and 
Meltzer states that Parke, Davis & Company's preparations have 
given better results than those of other firms, and caused none of 
the disagreeable untoward symptoms which will be named shortly. 
Two grains of Parke, Davis & Company's powder are equal to 5 
grains of the fresh gland, the ordinary sheep's thyroid weighing about 
24 grains. When the remedy is first employed we usually give 
about 1 grain of P. D. & Co.'s powdered gland, which is gradually 
increased a grain a day until about 6 grains a day are reached, when 
a halt is made and the effect of this dose watched for some days. If 
the patient does not manifest symptoms of overdose on the one hand 
or fail to improve on the other, then the dose may be gradually 
increased. No more than 15 grains of the dried gland should be given 
each day, and this quantity should be divided into several doses. 

Thyroid gland has been used very largely in the treatment of cre- 
tinism with success only second to that attained in the therapy of 
myxedema, and with asserted success in dwarfism, excessive obesity, 
psoriasis, and scleroderma. After marked improvement or apparent 
cure has been effected by the treatment, it is necessary for the patient to 
continue using thyroid extract indefinitely, for if it is discontinued the 
myxcedema returns. The remedy may be given in minute daily doses 
or in full doses for several days at the end of every three weeks or a 
month. Though the latter plan is the more disagreeable, it is asserted 
to possess a greater therapeutic and preventive value. The rapid 
growth of cretins under thyroid gland therapy may lead to bending 
of the bones, and care should be taken that too much exercise on the 
feet is prevented. When used in obesity, an increased amount of 
nitrogenous food should be supplied to prevent loss of strength, as 
this gland causes increased catabolism not only in the fatty, but 
also in the proteid parts of the body. Under its influence the body 
cannot assimilate glucose if it is ingested in full doses, and glycosuria 
develops. In obese diabetics the gland is probably a dangerous drug 
for this reason. In the author's experience its effects are inconstant 
in obesity. It benefits some patients and is useless in others. 

Because of the very great effect of this gland upon nutritional 
processes it has been employed in a host of ailments in which 
there has been no prospect of producing good effects. Among these, 
however, some experiments have resulted so favorably that the 
use of the gland has received recognition, although we do not 
understand exactly how it does good. Thus in the dose of from 
5 to 20 grains (0.30-1.3) three times a day, according to the degree 
to which it produces its effects, it has proved of value in acute mania 



448 DRUGS. 

and melancholia, puerperal and climacteric insanities, and in stuporous 
states with primary dementia. The treatment should be persisted in 
for at least thirty days, according to Mabon and Babcock. Recently 
the use of full doses of thyroid gland has been strongly recommended 
for the prevention and relief of the early symptoms of eclampsia on 
the ground that it relaxes the renal bloodvessels, increases urinary 
flow, and also increases the elimination of urea. It has also been 
asserted that thyroid therapy is useful in the treatment of exophthalmic 
goitre, but this is positively contradicted. Indeed, it is claimed by 
some that this disease is made worse by its use, since in overdose 
the gland causes symptoms like those of exophthalmic goitre. Prob- 
ably it will be found that true exophthalmic goitre is not benefited, 
but it may be that the gland is useful when overgrowth, with atrophy 
of the parenchyma, of the connective tissues of the thyroid produces 
the enlargement. 

Thyreoiodine and Iodothyrine have been introduced as representing 
the therapeutic activity of the crude gland; but while they possess 
some action, they cannot be so used with the expectation of such good 
results as when the desiccated thyroid gland itself is resorted to. 

The dried gland (Glandular Thyroidce Sicca?) has been made official 
in the U. S. P. of 1900. The dose is 1 to 5 grains (0.06-0.30). 

In the B. P. the dried gland (Thyroideum Siccum) is also official, 
as is the Liquor Thyroidei, dose 5 to 15 minims (0.3-1.0). 

Untoward Effects. — Overdoses of thyroid produce violent headache, 
feeble action of the heart, and sometimes diarrhoea and vomiting. 
Should any of these symptoms come on, they are an indication for the 
complete stoppage of the use of the drug for some days, and a return 
to its use must be gradual. These symptoms can be avoided by 
cautious dosing and by keeping the patient in bed for some days 
after the treatment is inaugurated. A vegetable diet will also aid the 
treatment. 

TRICHLORACETIC ACID. 

Trichloracetic Acid, U. S., is a compound of chlorine and acetic 
acid, occurring in deliquescent crystals, and used as a rapid, active 
escharotic upon venereal and other warts. A peculiarity in its effect 
is that it produces a dry scab which speedily falls off, leaving a heal- 
ing surface beneath. It is also claimed that its action is not followed 
by secondary inflammation and pain. It is used by applying a crystal 
to the wart or other growth. 

TRIKRESOL. 

Trikresol is a combination of ortho-, meta-, and paracresol, bodies 
allied to creolin and carbolic acid. Trikresol appears in commerce 
as a white liquid, smelling somewhat like creosote, and soluble in 



TURPENTINE. 449 

water in the proportion of about 2\ per cent. It forms a clear solu- 
tion, and does not benumb the skin as does carbolic acid. It is also 
much less irritant and less poisonous than carbolic acid or bichloride 
of mercury. 

Therapeutics. — Trikresol is used as an antiseptic in surgery in 1 
per cent, solution. In the strength of 1:1000 to 1:500 it may be 
employed as an antiseptic collyrium in ophthalmic practice, in which 
field it has proved very useful. 

TRIONAL. 

Sulphonethylmethanum, U. S., trional, is related, both chemically 
and therapeutically, to sulphonal, and is practically identical with 
that drug in its effects on the general system. It occurs in shining, 
odorless, colorless plates with a very faint, bitter taste, and is soluble 
in 195 parts of water. Trional is used for the relief of insomnia of a 
functional type, and the sleep produced ordinarily ensues in about 
twenty to thirty minutes after the drug is taken, and lasts five to six 
hours. The dose is 15 to 30 grains (1.0-2.0). Doses larger than 15 
to 30 grains should never be given continuously, and it is always a 
good plan after the drug has been given for five or six consecutive 
days to stop its use for two or three days. It is well to order for the 
patient who is taking trional one of the saline purgatives daily, partic- 
ularly if there is any tendency to constipation. 

Trional is slightly soluble in water and very soluble in alcohol. 
Advantages in its use are lack of disagreeable taste and the absence 
of symptoms of circulatory depression. The best way to administer 
trional is in hot broth or tea or whiskey. It is wise to decrease gradu- 
ally the dose if the drug is taken night after night. Like sulphonal, 
trional is apt to make the patient drowsy the day after its ingestion. 

When trional is taken in full dose for several weeks, it produces 
alterations in the blood which are manifested by hsematoporphyrinuria 
— a state in which the urine is dark red or almost black. The drug 
should be stopped at once when the urine becomes red and saline 
purgatives must be used freely. 

TURPENTINE. 

Terebinthina, U. S., occurs in two forms — namely, as turpentine 
derived from the ordinary yellow pine (Pinus palustris) and other 
varieties of pine, and as Canada turpentine (Terebinthina Canadensis, 
U. S. and B. P.) derived from Abies balsamea, or silver fir, or species 
of cone-bearing trees other than Pinus palustris. The turpentine 
derived from the latter sources is sometimes called " Balm of Gilead." 

Much confusion often exists in students' minds as to the difference 
between oil of turpentine (Oleum Terebinthina, U. S. and B. P.) and 

29 



450 DRUGS. 

spirit of turpentine, both of which are the same substance under a 
different name. This oil is not, however, the same thing as ''tur- 
pentine/' for the oil is distilled from turpentine. The distilled oil 
is a thin, clear fluid having a peculiar odor and taste, and is irritant 
to the skin and mucous membranes. It is exceedingly inflammable, 
should never be placed near a light, and if added to any strong 
mineral acid takes fire. 

When turpentine is spoken of in this book or in medicine generally, 
the doubly distilled oil of turpentine (Oleum Terebinthince Rectifica- 
tion, U. S.) is what is meant unless the contrary is stated. 

Physiological Action. — Turpentine when taken internally produces 
a sense of warmth in the stomach, a quickened pulse, a warm skin, 
and slightly accelerated breathing. In overdose it may cause intoxi- 
cation. Upon the circulation it produces a very slight rise of arterial 
pressure, increased pulse-rate, and increased heart-force. On the 
nervous system the drug, in large amounts, causes loss of sensation 
before it affects voluntary motion. 

The drug is eliminated by the kidneys and lungs, and gives the 
odor of violets to the urine. 

Poisonous doses cause strangury, bloody urine, renal inflammation, 
and cyanosis, with dilated pupils and gastro-enteritis. 

In persons with an idiosyncrasy to this drug, erythematous, papular 
or vesicular eruptions may follow its external or internal use. 

Therapeutics. — External Use. — Turpentine is used as a local 
application for the purpose of producing counterirritation over any 
area where deep-seated inflammation exists. Under these circum- 
stances it is almost always used in the form of a stupe, made as fol- 
lows: Place a tin cup containing the turpentine in a vessel containing 
hot water, so that the turpentine may be warmed without coming near 
a flame. Dip a piece of flannel into very hot water and wring it out 
in a twisted towel, and when it is so dry that no water drips from it, 
dip it into the hot turpentine and wring it out again to free it from 
any excess of the drug. The cloth, while hot, should be applied, and 
allowed to remain until discomfort ensues, when it should be with- 
drawn, as it will blister the skin if left on too long. Children and 
adults suffering from bronchitis may be rubbed on the chest with tur- 
pentine with much relief, but it should be diluted with sweet oil, half 
and half, or even two-thirds of oil, particularly if the patient is a child . 

Internal Use. — Turpentine is used internally as a stimulant of 
a diffusible type in the course of the exhausting fevers, particu- 
larly if flatulence exists or if ulceration of the bowels is present. 
In typhoid fever turpentine stupes, turpentine enemata, and the 
administration of the drug by the mouth are the best ways to over- 
come tympanites. At the end of the second week, when the tongue 
is red, dry, cracked, and brown, the teeth covered with sordes, and 
tympany is well marked, turpentine may be used in emulsion in the 
dose of 5 to 10 minims (0.3-0.60) three times a day with advantage. 



TURPENTINE. 451 

Again, in convalescence from typhoid fever, when diarrhoea is per- 
sistent and relapses are constant and due to an unhealed state of 
Peyer's patches, turpentine is the remedy par excellence. 

In intestinal and other passive hemorrhages, such as menorrhagia 
or hematuria, the drug is often of service. 

For the tape-worm, turpentine is given in the dose of J to 1 
ounce (16.0-30.0), mixed with an equal amount of castor oil. This 
treatment is a somewhat dangerous practice, but is efficient. In 
chronic and well-advanced kidney disease large doses of powerful 
diuretics are often required to stimulate the kidneys sufficiently 
to increase urinary flow, and turpentine may be used under these 
circumstances; but it is contraindicated if any acute irritation is 
present, as it may under these conditions produce suppression. 

Turpentine is contraindicated in the presence of any acute inflam- 
mation of the gastrointestinal tract and in acute nephritis. 

In lumbago the dose of 2 minims (0.10) is said to be very useful, 
and many have found the vapor of turpentine of value in bronchitis of 
a subacute or chronic type when inhaled from boiling water. (See 
Inhalations, Part III.) In gleet it is given by the mouth to stimulate 
the genito-urinary tract. Turpentine has been found of value in the 
treatment of purpura hemorrhagica. 

Administration. — Turpentine may be given for the relief of flatu- 
lence by placing 5 minims (0.3) on a piece of sugar, or in emulsion 
(Emulsum Olei T erebinthinaz , U. S.) dose i to 2 fluidrachms (2.0-8.0). 

A more agreeable preparation, not to be used in typhoid fever, is 
that recommended by Bartholow, as follows: 

1^— Olei terebinthinae f 5j (4.0\ 

Olei amvgdal. expres f Bss (16.0). 

Tincturae opii f 3ij (8.0). 

Mucil. acacias . # f5v (20.0). 

Aquae laurocerasi f§ss (16.0). — M. 

S. — A teaspoonful (4.0) every four hours for tympanites. 

When used as an enema the following is useful: 



j5j (30.0). 
fgjss (45.0). 
gr. xx (1.3). 
f" Sss (16.0). 
fgx (300.0).— M. 
ynipanites and to aid in the 



1$ — Olei terebinthinae 
Olei olivae 
Camphorae . 
Mucil. acacise 
Aquae 
S. — To be injected as an enema for the relief of 
removal of hardened feces. Stir thoroughly before using. 

The author most commonly employs turpentine in enema by adding 
it to milk of asafcetida, 1 drachm to 2 drachms (4.0-8.0) to 6 ounces 
(180.0). 

The Liniment of Turpentine (Linimentum Terebinthinae, U. S. 
and B. P.) is largely used as a stimulating application to sprains and 
enlarged joints. 

Turpentine applied with a brush to the part affected is of service 
in ringworm. 

The ointment of turpentine is used as a counterirritant and stimu- 



452 DRUGS. 

lant to the part to which it is applied. The liniment acts in the same 
way when applied to sprains and bruises. 

The following preparation is also official in the B. P. : Linimentum 
Terebinthina Aceticum. 

UROTROPIN. 

Uro tropin (Hexamethylenamina, U. S.) , made in the United States also 
under the name Uritone, is produced by the action of ammonia upon 
formaldehyde, and appears in colorless crystals which are odorless and 
have an alkaline reaction. At 77° F. it dissolves in 1.5 parts of water. 
When first introduced it was thought when taken internally to set free 
formaldehyde in the urine. Cammidge has proved this to be incorrect, 
and that the antiseptic power depends on other urotropin products. It is 
used to render the urine acid and clear when this secretion is excessively 
alkaline, loaded with phosphates and amorphous urates, and purulent. 
It allays irritability of the bladder due to this cause, as, for example, that 
due to ammoniacal cystitis. It is largely employed to render the urine 
sterile in cases of typhoid fever and to act as an intestinal antiseptic. 
For the former purpose it is of great value not Only in avoiding sec- 
ondary vesical disease, but in preventing the spread of the disease to 
others. The dose is 5 to 10 grains (0.30-0.60), taken twice or thrice 
a day, dissolved in a half-pint of carbonated or plain water. 

Several cases have been recorded in which the continued use of 
large doses has resulted in producing hematuria and strangury. 

UVA URSI. 

Uva Ursi, U. S., Bearberry, is the leaves of Arctostaphylos uva 
ursi, a widely distributed evergreen shrub. The drug is known in 
the B. P. as Uva ursi folia. Its active principle is arbutin, some- 
times called ursin. 

Therapeutics. — Uva ursi is employed in medicine as a weak, astrin- 
gent diuretic, possessing alterative power over the genito-urinary appa- 
ratus. It is used in pyelitis, cystitis, and in chronic gonorrhoea or 
gleet. When taken in overdose it escapes from the body as hydro- 
chinone, making the urine dark-colored or black. 

Administration. — Arbutin itself is often used in the dose of 3 to 5 
grains (0.20-0.30). The dose of the extract (Extracturn Uva Ursi. 
is 1 to 4 grains (0.06-0.25), of the fluid extract (Fluidextractum Uva 
Ursi, U. S.) is 2 to 4 drachms (8.0-16.0) three times a day. An infu- 
sion (Infusum Uva Ursi) is official in the B. P., dose 1 to 2 ounces 
(30.0-60.0). 

VALERIAN. 

Valerian {Valeriana, U. S.) is the rhizome and rootlet of Valeriana 
officinalis, a plant of Europe, but cultivated in America. It is official 
in the B. P. as Valeriana rhizoma. Its active principle is apparently 
a volatile oil (Oleum Valeriana). It also contains valerianic acid. 



VERATMNA. 453 

Physiological Action. — Valerian is a very feeble sedative to the 
nervous system, tending to produce nervous rest. In male cats it 
causes sexual excitement to a great degree, probably from its odor. 
When very large doses are given to man, it causes a sense of warmth 
in the stomach, a slightly quickened pulse, and sometimes nausea and 
vomiting. Still larger amounts produce purging and mental hebetude. 

Therapeutics. — Valerian is used alone or in combination with other 
drugs to quiet nervous females and to relieve nervousness and insom- 
nia. In hysteria it is often very serviceable, and combined with mor- 
phine it has been much used in the treatment of delirium tremens. 

Administration. — The fluid extract (Fluidextr actum Valeriana?, U. S.) 
is given in the dose of 1 fluidrachm (4.0), and the ammoniated 
tincture (Tinctura Valeriana? Ammoniata, U. S. and B. P.), in the 
dose of 1 to 3 drachms (4.0-12.0). These are the best preparations for 
ordinary use. The infusion, which is not official, is given in the dose 
of a wineglassful, while that of the simple tincture (Tinctura Valeri- 
ana?, U. S.) is 1 to 3 drachms (4.0-12.0). The dose of the oil (Oleum 
Valeriana?) is 2 to 4 minims (0.05-0.25). 

VALERIANIC ACID. 

Acidum Valerianicum is an oily, colorless liquid of a strong odor 
and burning taste, but is not employed in medicine except in the form 
of its salts, such as the valerianate of zinc, iron, quinine, or ammo- 
nium, all of which are employed, partly for their sedative effects and 
partly for their influence as tonics. 

The dose of Zinci Valeras is i to 3 grains (0.03-0.20), that of 
Quinina? Valeras 1 to 3 grains (0.06-0.20), of Ferri Valeras 2 to 10 
grains (0.12-0.60), and of Ammonii Valeras 2 to 10 grains (0.12- 
0.60). Under the name of "the pili of the three valerianates" 
Goodell recommended the following in nervousness and hysteria: 

K — Quininae valerat., 

Ferri valerat., 

Ammon. valerat aa 9JQ.3). — M. 

Ft. in pil. No. xx. 

S. — One or two three times a day 

VERATRINA. 

Veratrina, U. S. and B. P., is an alkaloid derived from the 
seeds of Asagrcea officinalis, and occurs in a grayish powder, which 
if it enters the nostrils produces violent sneezing which continues for 
hours. 

Physiological Action.— Nervous System. — Veratrine has little effect 
on the cerebrum, but it excites the spinal cord and the voluntary mus- 
cles, thereby giving rise to tetanic or tonic convulsions, which are never 
clonic or epileptoid. The dominant action of the drug is paralytic, 



454 DRUGS. 

and the nervous symptoms just named soon give place to paralysis. 
The muscles lose their contractile power and the nervous centres are 
depressed. 

Circulation. — In poisonous dose the heart is slowed by the drug, 
greatly weakened, and finally stopped in diastole. After death the 
heart is found to be soft and flabby. In smaller doses it at first slows 
the pulse by stimulating the peripheral inhibitory nerves and the 
centres in the medulla, but later these parts are paralyzed. It first 
stimulates the vasomotor centre, then paralyzes it. 

Respiration. — The drug kills by failure of respiration, due to 
paralysis of the respiratory centres. 

Temperature. — Veratrine always causes a decrease in bodily heat. 

Poisoning. — The symptoms of poisoning in man are collapse, a 
pale, cold, wet skin, pinched features, and a rapid, thready pulse, 
accompanied by violent vomiting and muscular tremors. Tetanic 
convulsions may come on and resemble those of strychnine in that 
they arise from the slightest touch or draught of air; after death the 
muscles will be found to have lost their irritability. 

Therapeutics. — Veratrine is never used internally. It is employed 
chiefly in the form of an ointment rubbed into the skin over parts 
affected by muscular rheumatism and rheumatic joints and over neu- 
ralgic nerves. The official ointment (Unguentum Veratrinw, U. S. 
and B. P.) or the oleate {Oleatum Veratrinw, U. S.) should be used, 
the latter most carefully, as absorption of the drug may take place in 
sufficient quantity to poison the patient. 

. VERATRUM. 

Veratrum, U. S., Indian Poke, Poke Root, or Swamp Hellebore, is 
an American plant largely used for the purpose of allaying inflam- 
mation. Until recently it was official in the B. P. under the name of 
Veratri viridis rhizoma. 

It probably contains a number of principles, the chief of which 
are, however, jervine and veratroidine. 

Veratrum and aconite are the safest and best circulatory depres- 
sants for use in adults. 

Physiological Action. — The physiological action of this drug is to 
be considered under the effects of its two alkaloids before the com- 
plete effect is studied. 

Jervine. 

When jervine is given in full toxic dose it causes great slowness 
of movement, relaxation of the muscles, through which thrills con- 
tinually run, and finally the animal falls to the ground. Violent epi- 
leptiform convulsions may now ensue, but no tetanus is present. The 
convulsions soon give place to paralysis, and are characterized by 






VERATRUM VIRIDE. 455 

their lack of force. Sensation is not affected until the near approach 
of death brings on anaesthesia. There is no evidence of gastro-enteritis 
and no vomiting or purging. The saliva is always increased and 
pours from the mouth. Death results by failure of the respiratory 
centres and an almost simultaneous failure of the heart. The heart 
and circulation are greatly depressed, and the pulse-rate and force 
are far below their normal rate and strength. 

The blood-pressure is very low, except when a convulsion pro- 
duces a temporary rise, but the condition of the vagi is apparently 
normal. Jervine acts as a direct depressant to the vasomotor centres. 
The convulsions are due to disturbance of the circulation at the 
base of the brain (Wood), and the spinal cord is directly depressed by 
the action of the jervine on its motor tracts. 

Veratroidine. 

This alkaloid is much more irritating than jervine, and in over- 
dose causes vomiting and purging. The muscular twitchings and 
convulsions caused by jervine are also produced by veratroidine, but 
are generally not so severe. It also depresses the spinal cord in its 
motor tracts. 

On the circulation veratroidine slows the pulse by stimulating the 
pneumogastric centres, but finally quickens it if given in very large 
doses, by paralyzing the peripheral vagi. 

The following summary, given by Wood, of the circulatory effect of 
veratrum, from a study of its alkaloids, is so brief and terse as to be 
worthy of insertion here: ''Veratrum slows the pulse by a direct 
depressant action on the heart muscle (jervine) and by stimulating 
the pneumogastric nerves (veratroidine); it lowers blood-pressure by 
an action on the heart muscle (jervine) and by depression of the 
vasomotor centre (jervine)." 

Poisoning. — Veratrum, while one of the most powerful drugs we 
have, is one of the least dangerous, since it almost invariably causes 
vomiting before enough of the drug is absorbed to produce serious 
consequences. The vomiting is partly due to the veratroidine and 
partly to the presence of an irritant resin. In poisoning, cardiac 
stimulants, atropine, external heat, the placing of the head below the 
feet on an inclined plane, and the use of strychnine as a respiratory 
and nervous stimulant are to be resorted to. 

Therapeutics. — The chief use of veratrum is as a circulatory seda- 
tive in acute, sthenic, or dynamic inflammations. In 'pneumonia, 
pleurisy, acute hepatitis, peritonitis, and cerebritis it is of the greatest 
value if given at the proper stage, when only congestion or hyperemia 
is present. After the onset of the lesions following this period its 
use is not only valueless, but harmful. The objection to the employ- 
ment of veratrum in peritonitis and cerebritis lies in its tendency to 



456 DRUGS. 

produce vomiting, which is, of course, harmful when the peritoneum 
is inflamed. For this reason aconite is preferred to veratrum in 
peritonitis. Owing to its physiological influence, veratrum bleeds 
a man into his own bloodvessels, and the indications for its use 
are the same in inflammation as they would be for bleeding. In 
puerperal fever it has been highly recommended, but must be most 
carefully employed. Many practitioners consider veratrum by far 
the best remedy in puerperal eclampsia. If given in this condi- 
tion, the dose must be large, as much as 20 to 30 minims (1.3-2.0) 
of the fluid extract hypodermically, and followed by 5-minim doses 
till the pulse is reduced to the normal rate. These heroic doses are 
said to be absolutely necessary and not to cause any evil effects. Its 
use is indicated only in cases with high arterial tension, a bounding 
pulse, and suffused face. It probably acts in eclampsia chiefly by its 
depressant effect on the motor tracts of the spinal cord. It is also of 
value in excessive cardiac hypertrophy and in the irritable heart of 
strong, healthy men. In aneurism, where the circulatory disturbance 
is great and the arterial pressure high, the drug may be used, with 
great care, to decrease the pressure and prevent rupture of the dis- 
eased vessel. 

Contraindications. — Veratrum is contraindicated in all conditions 
of depression or exhaustion, and if vomiting is feared. It must not 
be given in peritonitis or gastritis, as it may cause emesis, and in this 
way disturb and irritate the abdominal contents. 

Administration. — In inflammation the drug should be given every 
half-hour or hour, and at least 1 minim (0.05) of the fluid extract should 
be used at each dose in a healthy adult. In the course of two or three 
hours or less the skin becomes moist or relaxed, the pulse slower and 
less excited, and slight nausea may be present. These symptoms show 
that the drug is exerting its influence, and it should now be withdrawn 
or in very sthenic cases pushed a little farther. If vomiting comes 
on before the drug has acted on the circulation, 5 to 10 minims (0.35- 
0.65) of laudanum should be given fifteen minutes before each dose 
of veratrum viride. A good preparation to employ is the tincture 
(Tinctura Veratri, U. S.), dose 5 to 20 minims (0.30-1.30). The fluid 
extract (Fluidextr actum Veratri, U. S.) is given in the dose of 1 to 3 
minims (0.05-0.20). Under the name of Norwood's Tincture a 
saturated tincture is largely sold. It is not official, and ought never 
to be used for this reason. 

VERONAL. 

Veronal is a compound of urea, its chemical name being diethyl- 
malomylurea. Its action is allied to that of trional and it is said to 
have no effect upon the blood or respiration. 

It is used as a hypnotic, to a limited extent as a pain reliever, 
and is commonly given in the dose of from 5 to 10 grains taken 



WARBURG'S TINCTURE. 457 

before retiring for the night. The drug is prone to lose its effect if 
given continuously for more than two weeks. It may be given in 
capsule or solution. 

VIENNA PASTE. 

Potassa cum calce is a milder and more manageable escharotic 
than is caustic potash, and is used for the same purposes. (See 
Caustic Potash.) 

WARBURG'S TINCTURE. 

Warburg's Tincture is a complex liquid formed by the mixing 
together of no less than thirteen ingredients. Its inventor, Dr. War- 
burg, held its composition as a secret for a time, but finally made it 
public. Since he published the original formula it has been consid- 
erably altered, and some of the preparations now sold as Warburg's 
tincture contain none of the original ingredients. Further than this, 
some of these ingredients are now not obtainable. It ought to be 
made as follows, if possible: 

Aqueous extract of aloes 28 grains. 

Rhubarb 448 " 

Angelica-seed 448 " 

Elecampane •. . 224 

Saffron 224 " 

Fennel 224 " 

Gentian 112 

Zedoary-root 112 " 

Cubeb 112 " 

Myrrh 112 " 

White agaric 112 

Camphor . 112 " 

Sulphate of quinine 1280 " 

Dilute alcohol enough to make 8 pints. 

The coarse vegetable portions of this list are to be ground into a 
coarse powder, and the myrrh and camphor, which have been pre- 
viously pulverized, added to them. The entire mass, less the quinine, 
is then digested for twelve hours in a well-covered vessel on a water- 
bath, the alcohol being prevented from evaporating as much as pos- 
sible. The liquid is now to be strained under pressure and the 
sulphate of quinine added and dissolved. 

Therapeutics. — Warburg's tincture, next to pilocarpine, is the most 
powerful sweat-producer that we have, and possesses in addition 
remarkable antimalarial power. Its advantages rest in its favorable 
action where congestions accompany the malarial paroxysm. 

Administration. — To be of value Warburg's tincture should be 
given according to the following rules: The bowels of the patient 
should be first opened thoroughly by a saline purge, and J ounce 
(16.0) of the tincture should be given in one dose undiluted, no other 
drink being taken. After the lapse of two or three hours a second J 



458 DBUGS. 

ounce (16.0) is given in the same way, and very shortly a profuse sweat 
appears, which often marks the crisis of the disease, and recovery 
soon takes place. 

XKROFORM. 

Xeroform, or Tribromphenol-bismuth, is, as is seen from its second 
name, a combination of bromine, carbolic acid, and bismuth. It was 
introduced as a substitute for iodoform in surgical dressings. Its 
chemical constitution indicates that it possesses antiseptic properties, 
and its drying power and great volume enable it to render a wound 
antiseptic. As it does not contain iodine, it naturally lacks the 
peculiar virtues of iodoform, and, on the other hand, has none of its 
peculiar disadvantages. 

ZING ACETATE. 

Zinci Acetas, U. S. and B. P., occurs in the form of white mica- 
ceous crystals, which are efflorescent and quite soluble in water. It 
acts as a decided astringent to the skin and mucous membranes, but 
is less astringent than the sulphate of zinc. It is used as a collyrium 
in eye diseases, such as conjunctivitis, in the strength of 1 to 2 grains 
(0.06-0.12) to the ounce (30.0). In gonorrhoea it is often employed 
instead of the acetate of lead in injections of the strength of 1 to 20 
grains (0.06-1.3) to the ounce (30.0) of rose-water. 

The treatment of poisoning by acetate of zinc is that adapted to 
gastro-enteritis. (See Gastro-enteritis, Part IV.) 

Chronic poisoning by zinc is very rare; the symptoms consist in 
muscular palsies, neuritis, and cachexia. 



ZINC CARBONATE. 

Precipitated Carbonate of Zinc {Zinci Carbonas Pracipitatus, U. S. ; 
Zinci Carbonas, B. P.) is used as a protective, rather astringent pow- 
der over surfaces affected by weeping eczema or other skin lesions 
accompanied by similar moist discharges. It may be employed to fulfil 
all the indications commonly treated by the oxide of zinc. It is very 
largely used, not as the precipitated carbonate, but as the impure or 
native carbonate, under the name of calamine. 

The following prescription is useful for moist eczema: 

I$— Calaminse . . 3j (4.0). 

Ung. zinci oxidi . 5vij (28.0).— M. 

S.- — Apply to the eczematous spot. 

In cases of infantile intertrigo, or redness of the buttocks and geni- 
tals, from maceration due to liquid feces in infants suffering from 



ZINC SULPHATE. 459 

diarrhoea, or where the urine is irritating, the following lotion is 
useful : 

1^ — Pulv. calaminae, 

Pulv. zinci oxidi aa 5ij (8.0). 

Glycerini 5iv (16.0). 

Alcoholis fgij (60.0). 

Aquae q. s. ad Oj (480 c.c). — M. 

S. — Apply with a mop after each removal of the diaper. 

ZINC CHLORIDE. 

Chloride of Zinc {Zinci Chloridum, U. S. and B. P.) is a white, 
crystalline, deliquescent powder, of caustic taste and acid reaction, 
possessing considerable disinfectant power. It has been used as an 
eye-wash in the strength of 1 to 2 grains to the ounce (0.06-0.12: 
30.0), but is rarely so employed at present. The same solution may 
be used as an injection in the second stage of gonorrhoea. Small 
cutaneous cancers, particularly if near bloodvessels, may be advan- 
tageously treated by the following salve, which is efficacious and 
mummifies the tissues so that hemorrhage is prevented: 

1$ — Zinci chloridi 3j (4.0). 

Pulv. amyli 3iij (12.0). 

Cocainae hydrochlorat gr. xxx (2.0). 

Aqua- destillat 5ij (8.0).— M. 

S. — Apply as a paste. 

Under the name of Liquor Zinci Chloridi, U. S. and B. P., is pre- 
pared a solution of the salt for disinfecting purposes of the strength 
of about 50 per cent. 

ZINC SULPHATE. 

Zinci Sulphas, U. S. and B. P., is a white, somewhat efflorescent 
salt, of a sharp, acid taste, and soluble in water. In large amounts 
it acts as an irritant, and is employed as an irritant peripheral emetic 
in the dose of 10 to 30 grains (0.60-2.0). It is not so severe as sul- 
phate of copper in its emetic and poisonous properties, and may be 
repeated if the first dose does not produce vomiting. In weak solu- 
tions it may be used as an astringent application by injection in gon- 
orrhoea and other affections of the urethral mucous membrane. In 
2-grain (0.12) pills it is sometimes given in serous diarrhoeas, particu- 
larly if it be combined with opium or minute doses of podophyllin (-^ 
grain [0.001] at a dose). In conjunctivitis and other eye affections 
the drug is used in the form of a wash. (See Conjunctivitis.) 



PAET III. 

REMEDIAL MEASURES OTHER THAN DRUGS - 
FOODS FOR THE SICK. 



ACUPUNCTURE. 



Acupuncture is a term applied to the insertion of a small pointed 
instrument into the tissues of any part of the body for the purpose of 
relieving pain, swelling, or dropsies. When used in painful affections 
it accomplishes its best results in lumbago and sciatica, particularly 
in the former. When treating lumbago in this manner the writer 
places two darning-needles in boiling water to render them aseptic, 
inserts them at right angles to the skin to the depth of one to one and 
a half inches, and allows them to remain in place for several minutes. 
They are then slowly withdrawn, care being taken to prevent their 
breaking. Often after this treatment the patient can at once move 
more freely, to his great delight. Ringer, with his usual clear clini- 
cal insight, has noted that this procedure is more successful in those 
who have bilateral pain than in those who have unilateral pain, and 
the writer has found this invariably true. 

In sciatica acupuncture is less successful than in lumbago, but 
should always be tried. The needle should be inserted until it 
reaches the nerve, and perhaps pierces its sheath, and it must be 
absolutely aseptic. Bartholow has recommended the use of a. hypo- 
dermic needle for the simultaneous injection of a few minims of 
chloroform or morphine. Sometimes the best results follow from 
inserting the needle immediately below where the nerve finds exit 
from the pelvis. In other cases it is asserted that the insertion of a 
needle on the sound side over a spot corresponding to that which is 
painful may be beneficial. Acupuncture is useless in acute rheu- 
matism and for the lumbar pain accompanying fevers. 

Sometimes a rhigolene spray may be used to freeze the skin over 
the parts with advantage in lumbago or sciatica. 

Acupuncture is occasionally resorted to for the relief of dropsy, 
but it is not commonly employed, although it is often a useful measure 
in this condition. When the skin of the limbs becomes so tense with 
an effusion as to endanger its life, the tension should be relieved 
by incisions, not punctures; but saline purges are better for the re- 

( 461 ) 



462 REMEDIAL MEASURES OTHER THAN DRUGS. 

moval of dropsy, if they can be used. Punctures rapidly close and 
cause local indurations, while incisions remain open and permit free 
drainage. Immediately after the incisions are made the parts are 
to be dressed with cotton previously saturated with boric-acid solution 
and dried, or with absorbent cotton sterilized by baking in an oven. 
It is hardly necessary to point out that the incisions must be made 
with antiseptic precautions. (See Antiseptics.) 

ANTISEPTICS. 

The term "antiseptic," as generally used, does not necessarily 
imply the power to destroy pathogenic germs. Any substance which 
inhibits the growth of micro-organisms, which destroys or renders 
innocuous the poisonous products of their action upon the tissues of 
the body, or which retards or prevents the absorption of such products, 
is properly termed antiseptic. Since germicides necessarily possess 
antiseptic attributes, they should, strictly speaking, be classed with 
antiseptics; in this portion of the work, however, only such drugs as 
are sufficiently innocuous to allow of their use in the human body or 
upon its surface will be considered. Some of these — as, for instance, 
carbolic acid and bichloride of mercury — are efficacious solely from 
their germicidal properties. Others, and of this class iodoform is the 
most important and typical example, exert their influence, not upon 
the micro-organisms, but upon the toxic substances produced by these 
organisms. 

Of the long list of antiseptics which have within recent years received 
warm commendation at the hands of individual writers, compara- 
tively few have retained the confidence of the profession after pro- 
longed trial. Only these few well-proved drugs will be discussed in 
this section. 

Heading the list, and in its germicidal power surpassing all others, 
is Bichloride of Mercury. Long since, the researches of Koch have 
shown that this salt is efficacious as a germicide in a watery solution of 
1: 50,000. He states, however, that where albumin is present the 
bichloride is decomposed and rendered inert. The same change is 
observed when solutions are allowed to stand for some length of time, 
even when distilled water is used as a solvent. By the addition of 
either sodium chloride or a weak acid such decomposition is prevented. 
From this it follows that under ordinary circumstances solutions 
of bichloride should be freshly prepared, or, if it is desirable to keep 
them for a long time, a sufficient amount of sodium chloride should 
be added to prevent precipitation of the sublimate. Koch advised that 
as much salt should be added as would equal the weight of the sub- 
limate. Other observers, however, have advised ten times this weight 
of sodium chloride. 

Since whenever bichloride solutions are used in wounds or in cavities 
of the body they are brought in contact with blood-serum or other 



ANTISEPTICS. 463 

albumin-bearing substances, care must be taken that the antiseptic 
powers of the mercury lotion are not destroyed by the decomposition 
of its active principle. The power of the solution may be preserved 
by using it in such excess that the chemical change has practically 
no effect, or by combining with it, as stated above, an acid which 
will not in itself be unduly irritating to raw surfaces. This end is 
accomplished by tartaric acid. In making up a solution, 1 part of 
bichloride and 5 parts of tartaric acid are added to as much water 
as is needed. Thus, in making up a solution of 1 : 1000 for surgical 
purposes, the following prescription may be employed: 

R — Hydrarg. chlorid. corros. . . gr. xv (1.0). 
Acid, tartaric. . . gr. xv vel ^j (4.0). 
Aquse dest Oij (960 c.c.).— M. 

In the treatment of ordinary wounds bichloride solutions are used 
in the strengths of 1:500, 1: 1000, 1:2000, and 1: 4000. For the 
irrigation of large cavities solutions of a strength greater than 1 : 10,000 
should rarely be employed; and even these dilute lotions have, when 
used in the peritoneal cavity, caused toxic symptoms. The 1 : 2000 
solution is the one generally employed for sterilizing wounds and irri- 
gating during operations. Solutions of 1 : 500 or 1 : 1000 are used 
in cleansing the surface of the body. 

The ordinary method of preparing the surface of the body for oper- 
ation is as follows: The part is first thoroughly scrubbed with green 
soap and warm water, is shaved, and is washed as before. It is then 
cleansed with alcohol or ether, after wmich a scrubbing with bichloride 
solution of 1 : 1000 should follow. If no surgical interference is imme- 
diately indicated, the whole operative region should be enveloped in 
towels wrung out in a solution of 1: 2000, and kept thus protected 
until the surgeon is prepared to operate. The moment the skin is 
incised no lotion stronger than 1: 2000 should be employed; or if the 
more powerful solutions are used they should immediately be flushed 
out with one of less strength. The dressings, unless some particular 
form is used, may consist of boiled, bleached, and sun-dried gauze, 
soaked in a 1 : 500 bichloride solution and subsequently washed and 
wrung out in a 1 : 4000 dilution of the same antiseptic. 

Next in popularity among the antiseptic preparations is Carbolic 
Acid and its solutions. The particular value of this drug lies in 
the fact that its potency is equally developed in both albuminous 
and non-albuminous solutions. Like the mercury salts, its dis- 
advantage lies in its toxic properties. It is usually used in solu- 
tions of 1 : 20 and 1 : 40. The carbolic acid of commerce is found 
in liquid form. In making solution for surgical purposes an ounce 
of this liquid is added to 20 or 40 ounces of water, according to the 
strength of the solution desired. Although carbolic acid is soluble 
in 15 parts of water, solution does not take place immediately, and 
in making solutions of a strength of 1 : 20 either the water must 
be hot or a certain amount of time and considerable agitation of the 



464 REMEDIAL MEASURES OTHER THAN DRUGS. 

mixture are required, otherwise globules of almost pure carbolic 
acid are deposited in the bottom of the tray or vessel into which the 
solution is poured, and these, on coming in contact with instruments 
or with the hands of the operator, exert an undesirable cauterant 
effect. 

The 1 : 20 solution is used for the disinfection of instruments and 
the cleansing of surfaces. For half an hour before an operation it is 
customary to submerge in a solution of this strength all instruments 
which will be required; and when the surgeon is ready to use the 
instruments the solution is diluted to 1 : 40 by the addition of an equal 
volume of water which has been boiled. If a carbolic solution is em- 
ployed for irrigation or for cleansing sponges during an operation, it 
should not be stronger than 1 : 40. 

A property possessed by carbolic acid, which renders it an unsafe 
medium for the impregnation of gauze, is its volatility. After 
exposure of a few hours to the atmosphere it wholly evaporates, 
leaving not an antiseptic, but simply a sterile, dressing. This fact is 
utilized by the surgeon in the preparation of the deeper layers of the 
dressing, which come in immediate contact with the edges of the wound. 
Since all antiseptics are more or less irritating to raw surfaces, healing 
will be promoted by a sterile rather than by an antiseptic application. 
By moistening in a carbolic solution of 1 ,: 20 a piece of boiled and 
sun-dried gauze sufficiently large to cover the wound-edges, the anti- 
septicity of this dressing is assured, and in a very few hours the heat 
of the body causes evaporation of all the carbolic acid, leaving a 
sterile, non-irritating surface in contact with the wound. If protec- 
tive is used or oiled silk is applied beneath the dressing, these materials 
should be treated with carbolic acid in the same way. 

In addition to the toxic effect upon the patient, carbolic acid greatly 
irritates the hands of the surgeon, and if used in a strength of more 
than 1 : 40 causes so much benumbing of tactile sensibility that manipu- 
lative skill is seriously interfered with. The cracked and fissured 
fingers resulting from the use of carbolic lotions are familiar to all, 
and at times produce far more serious results than temporary pain 
and discomfort: many recesses are provided in the depths of which 
septic germs may successfully resist the action of antiseptic washes. 
There can be no question that septic poisoning has been frequently 
due to this fact. It is absolutely impossible to disinfect cracked or 
fissured hands. 

A 40 per cent, aqueous solution of formaldehyde gas is a power- 
ful disinfectant, but when used in efficient strength is both painful and 
irritating. In the strength of 1 : 2000, using normal saline solution as 
the diluent, it may take the place of bichloride lotion for flushing 
large cavities or cleansing extensive granulating surfaces. The 
vapor has its most useful application in disinfecting rooms, barracks, 
dressings, and instruments. (See Disinfection.) 

Iodoform occupies a unique place among antiseptics in having 



ANTISEPTICS. 465 

been ulmost universally accepted and used by surgeons and clinicians 
in spite of the fact that its germicidal action has been proved by 
laboratory research to be practically nil. It is found that nearly all 
forms of pathogenic germs grow abundantly upon culture materials 
the greater part of which is made up of iodoform, and that injections 
of such germs, mingled with large quantities of iodoform, produce 
the characteristic effect upon living tissues with almost as great cer- 
tainly as though this drug had not been used; furthermore, it has 
been shown that iodoform is not even sterile, and that as employed 
by surgeons it is frequently a cause of infecting previously aseptic 
wounds; moreover, it is poisonous. In spite of this overwhelming 
evidence against it the drug is still in favor. Recent researches 
have explained, in part at least, the reason for this contradiction 
between experimental and practical results. It has been well said 
that the human body is not a test-tube, and that bacteriological 
research cannot supplant the evidence of clinical observation. Elabo- 
rate investigation has shown that this drug acts as a powerful 
antiseptic, not by destroying germs, but by undergoing a decom- 
position in their presence, the products of which render the ptomaines, 
the result of germ-growth, inert. In this way suppuration is to a 
certain extent inhibited, or if present its disastrous effects upon the 
system at large are prevented, since these are due to ptomaine 
absorption rather than to a direct effect of the micro-organisms 
themselves. It has been apparently proved that ptomaines, in them- 
selves and without the presence of micro-organisms, can generate 
pus, but that where such ptomaines are mixed with iodoform before 
infection no pus is formed. If these septic chemical compounds 
are rendered inert, a powerful adjuvant to the destructive action of 
the germ upon living cells is removed, and thus the system is often 
enabled to overcome one enemy where two would have prevailed. The 
fact that iodoform is in itself not sterile is, from a practical stand- 
point, most important. Fortunately, sterilization is readily accom- 
plished. A thorough washing in a 1 : 1000 bichloride solution destroys 
all micro-organisms, and the powder, after being washed with freshly 
distilled water, may then be used without fear of producing infection. 

It will be readily understood from the foregoing that iodoform is 
of little service in aseptic wounds; that it becomes of utility in direct 
proportion to the foulness of discharge; and that -to exert its influence 
it must be applied directly to the part. It is liable, in suppurating 
wounds, to form a hard crust with the discharges, thus frustrating 
one of the most important indications in antiseptic surgery — i. e., 
drainage. Care should always be exercised to see that the exudation 
from the surfaces of a wound has a free exit. 

As employed in surgery, iodoform, after having been sterilized, is 
placed in small pill-boxes or wide-mouthed jars, over the opening of 
which is tied a single layer of antiseptic gauze; through this the iodo- 
form is sprinkled as desired over wound surfaces- 

30 



466 REMEDIAL MEASURES OTHER THAN DRUGS. 

Kreolin, or Creolin, a preparation obtained from English coal by 
dry distillation, has grown in popular favor, and because of its feeble 
toxic action is often preferred to carbolic acid. In addition to its 
powerful germicidal effect, it is non-irritant and practically non- 
toxic. The claim first advanced that this preparation was absolutely 
non-poisonous can no longer be supported, since cases have been 
reported where toxic symptoms have followed its use: these were 
probably due to individual idiosyncrasy, a factor which we can 
never hope entirely to overcome. It is certainly true that kreolin is 
the least poisonous of all the powerful antiseptics heretofore used. 
As an additional advantage in place of the harsh, irritating effect 
produced upon surfaces by carbolic acid solutions, kreolin exerts an 
influence very like that of an oily or mucilaginous preparation. 

The extravagant claims advanced for kreolin in regard to its germi- 
cidal power have not been confirmed by bacteriological investiga- 
tion. In solutions containing albumin it is not efficient as a germicide 
in strengths of less than 1 : 100, its power being somewhat less than 
that of carbolic acid; since, however, its toxic properties are much 
less marked than those of the latter drug, it can be safely used in 
stronger mixtures, and therefore, for practical purposes, its strength 
is greater. 

Kreolin, though insoluble in water, readily forms an emulsion quite 
as efficacious in its antiseptic properties as a true solution. Since this 
emulsion is opaque, it is scarcely applicable for immersing and steril- 
izing instruments, the latter not being readily found. It is admirably 
suited, however, for cleansing the hands, a 5 per cent, solution neither 
cracking the skin nor benumbing the sensory nerves. In irrigating 
large wounds, cavities of the body, and particularly as a means of 
preventing sepsis or aborting it in gynaecological work, kreolin can be 
warmly commended. It may be employed in a strength of from 0.2 
to 5 per cent. 

Among the many antiseptic agents of less importance may be men- 
tioned Peroxide of Hydrogen. This drug comes in what is termed a 
ten- volume solution. By this it is meant that ten volumes of feebly 
combined oxygen are contained in each volume of the liquid. It is 
applicable, not to sterile surfaces, but to suppurating wounds and 
sinuses. It is alleged that peroxide of hydrogen immediately destroys 
the micro-organisms of pus, converting, in one or two applications, a 
septic wound into one which is sterile and which will promptly heal. 
It is used in the strength of from 5 per cent, up to full concentration. 
When this drug is poured into a suppurating sinus or cavity an 
ebullition takes place, which ceases only when the drug is exhausted 
or the dead material has been oxidized. It should never be used in 
a cavity from which the gas cannot readily escape. 

Chloride of Zinc has been extensively employed in some clinics as 
an antiseptic application. It is used in 10 per cent, solutions, and is 
applied when the field of operation is probably infected by pre-existing 



ANTITOXIN. 467 

pus-formation. Although bacteriological research has shown that 
this agent possesses feeble antiseptic power, clinical experience demon- 
strates its value when applied to infected surfaces. Lately the Sulpho- 
carbolate of Zinc has to a great extent replaced the chloride, as it is less 
toxic and irritating and far more potent. 

For the sterilization of mucous surfaces a saturated aqueous solu- 
tion ^of Boric Acid is commonly employed. More potent than this 
are the silver salts, nargol, protargol, and silver nitrate in solutions of 
1 : 2000 to 1 : 1000. 

An omission of the details of cleansing the hands of the surgeon 
and assistants in preparing for an antiseptic operation is scarcely 
permissible when writing upon the subject of antisepsis. The most 
approved method is as follows: 

The hands and forearms are thoroughly brushed in hot soap-suds 
for three minutes, after which the nails are carefully cleaned by 
wooden toothpicks and a brush, and the washing repeated; the hands 
are then washed in alcohol for one minute, special attention being 
paid to the nails; finally they are soaked for one minute in a solution 
of bichloride (1:1000), and during the course of the operation, if 
rubber gloves are not used, are occasionally washed in a solution of 
one-half this strength. If it is necessary to lift a chair, to turn the 
patient, or to touch any object which has not been previously steril- 
ized, the hands should be enveloped in towels wrung out in 1 : 1000 
solution or immediately washed again. Another method which has 
been found by Kelly to be the best, bacteriologically and practically, is 
to cleanse the hands and nails by scrubbing with hot water and soap, 
and then to immerse the hands and arms in a saturated solution of 
permanganate of potassium made with hot water. After this the skin 
is decolorized by immersion in a saturated solution of oxalic acid. 
Finally, the oxalic acid is washed off with hot sterilized water. 

Any method which irritates or cracks the skin of the hand is dan- 
gerous. The only certain way of avoiding infection from the hands 
of the operator lies in the use of rubber gloves. 

ANTITOXIN. 

The method by which protection is obtained by the use of antitoxic 
serum is best explained by the hypothesis of Ehrlich, which has with- 
stood the test of scientific investigation very well and is now generally 
admitted to be the true explanation of this interesting subject. It is 
assumed that all cells have the power of combining with the food- 
products that are needed by them for sustenance by means of receptors 
or parts which have an affinity for each form of food required. A 
cell may have many of these receptors, each of which is suited to 
the appropriation of a definite kind of food-stuff, and is unable to 
appropriate or become attached to any other variety of food. As soon 



468 REMEDIAL MEASURES OTHER THAN DRUGS. 

as a receptor has been utilized for the appropriation or attaching of 
a particle of food, the cell immediately makes another receptor, and, in 
many instances, makes a far greater number of these receptors than 
is necessary, particularly if the demand is very great. These extra 
receptors are, when made in excess, thrown off into the blood, where 
they exist unattached to the cells which originated them. 

The poisons or toxins of disease are knowm to be complex proteid 
bodies closely resembling food bodies, and therefore these poisonous 
products of bacteria unite with the receptors of a cell, and, instead 
of nourishing it, produce its death. An animal or a man may be 
naturally immune to a disease by reason of the fact that the cells in 
his body may be devoid of receptors capable of combining with a 
given poison, or by reason of the fact, which is the case in acquired 
immunity, that his cells have thrown off so many extra receptors into 
the blood that the toxins unite with them, and as they are unattached to 
cells the animal is not affected. These receptors are now called anti- 
bodies, and when the serum of a horse is injected into the tissues of 
a child suffering from diphtheria, this serum contains so many anti- 
bodies that the toxins of the disease are locked in the embrace of 
the antibodies in such large numbers that the cells of the body itself 
are not overwhelmed by the infection. In the case of diseases such as 
scarlet fever and smallpox, which rarely attack the same person 
twice, it perhaps may be said that immunity is conferred by the tissues 
being trained or educated, as it were, to prepare antitoxin in such 
large amounts when called upon that the entering wedge of a new 
attack is snapped off at the moment it begins to enter the field. 

The horse, being naturally able to resist diphtheria-infection to 
the extent of complete immunity, it becomes necessary, in order to 
make the resistance of his blood-serum absolute, to stimulate, if we 
may use such a term, his antitoxin-preparing powers, and with 
this object in view injections of the toxin derived from cultures of 
diphtheria germs are made into the blood of the naturally immune 
brute. As a result, the serum of the blood of the animal possesses the 
power of not only resisting diphtheria poison while in its own vessels, 
but also confers immunity of a temporary kind upon any other animal 
into whose body some of it is injected. It having been found experi- 
mentally that antitoxic horse-serum when injected into the susceptible 
guinea-pig renders that animal to a great extent insusceptible to inocu- 
lation by diphtheria, it was but a step to the use of the same agent 
for the protection of a child. 

Antitoxin for Diphtheria. 

While all of the antitoxins seem theoretically to promise well, in 
practice we find that only one is absolutely reliable, and it has received 
general recognition. This one is the antitoxin of diphtheria. The 
following process is followed in its preparation: a pure culture of the 
bacillus of this disease having been grown, colonies of the bacillus 



ANTITOXIN. 469 

are picked up off the culture gelatin and placed in tubes of blood- 
serum, which in turn are placed in an incubator and kept there until 
the bacillus has developed its full virulency, when flasks of bouillon 
are inoculated by the germs. These flasks are then placed in an 
incubator, where there is rapidly produced the diphtheritic poison in 
the bouillon. After a length of time sufficient for the development 
of the poison the fluid has added to it a small amount of some pre- 
servative, and is then filtered through unglazed porcelain, whereby 
all the bacilli and other particles are separated, the filtrate being a 
clear, straw-colored fluid. This is the fluid containing the toxin. 
The toxin of each flask varies in its power, so it is necessary to deter- 
mine its activity. This is done by injecting it into guinea-pigs, which 
animals are very susceptible. Usually from 2 to 100 milligrammes 
are required to cause death within a few days. A young, healthy 
horse now receives about 1.0 c.c. of the toxin by injection into a 
vein; that is, ten times the fatal dose for the guinea-pig, provided the 
fatal dose was 0.1. Horses are chosen because they are naturally 
immune, have large amounts of blood-serum, and are easily handled. 
Gradually increasing doses are given until the horse can readily receive 
several hundred times the first dose without any ill effects. The horse 
is now capable of rendering antitoxic serum, and he is bled. The 
blood-serum is separated and purified and is then tested to determine 
its power. The tests applied are such that the strength of serum is 
measured by units. 

An antitoxin unit is approximately equivalent to the unit established 
by Ehrlich in the Koniglisches Institiit fur experimentelle Therapie, 
Frankfort-on=the-Main, Prussia. It can be defined approximately by 
the following description of the process used : Ten times the smallest 
fatal dose of toxin is injected into a guinea-pig, and at the same time 
0.1 c.c. of the horse's serum is injected. If the guinea-pig survives, 
the serum is said to contain 1 unit of antitoxic power in each cubic 
centimetre, and as the dose given was only one-tenth of a cubic centi- 
metre it follows that each cubic centimetre is 10 times the amount 
of serum sufficient to protect a guinea-pig from 10 times a fatal dose 
of toxin. If this strength of serum were used, very large doses would 
have to be given to get any effect in man; so we are not satisfied with 
this result, and by continued dosing of the horse we may obtain, from 
his blood, serum which will be active in protecting the guinea-pig, 
not in the dose of 0.1 c.c, but in the dose of 0.001 c.c. Such a serum 
contains therefore 100 antitoxin units to the cubic centimetre. A 
dose of 5 c.c. of this strength would therefore give 500 antitoxin units. 
Even this is not satisfactory. Accordingly most of the serum on the 
market is so strong as to contain 500 or even 1750 antitoxin units in 
each cubic centimetre, so that 2 c.c. of the latter would be a dose of 
3500 units. These very high potency serums lose their efficacy if kept 
for any length of time, and are therefore not so reliable as the lower 
potencies unless they are fresh. All serum of whatever strength should 
be obtained as fresh as possible. 



470 REMEDIAL MEASURES OTHER THAN DRUGS. 

Antidiphtheritic serum has been used with asserted great success 
in cases of typhoid fever, epidemic cerebrospinal meningitis and in 
asthma. Under these circumstances it probably does* not exercise any 
specific effect, but is supposed to act by increasing leukocytosis and 
aiding in the elimination of poisons. McCallum states that its use 
improves the action of the heart and the tone of the vessels in 
typhoid fever. 

The use of antitoxin in diphtheria will be found discussed under 
that disease. (See Diphtheria.) 

Antitoxic serums have been used in tetanus and many other infec- 
tions. In none of them have results been obtained which render 
them equal in value with that used for diphtheria. Neither anti- 
pneumococcic nor antitubercular serums have proved of much value 
so far. Antitoxin fails in tetanus because the tetanus toxins unite 
so rapidly with the cells in the spinal cord and brain that by the 
time the symptoms are present and the antitoxin is given the damage 
is past repair, and the antitoxic bodies cannot combine with the toxic 
bodies because they are already combined with the cells of the tissues. 
If tetanus antitoxin is given at the time the wound is received, it is 
as efficacious as is antidiphtheritic serum in diphtheria. 

Antistreptococcus Serum. 

As is well known, infection by the streptococcus produces the more 
severe forms of septicaemia such as are met with in the puerperium, 
after injuries and operations, in erysipelas, and in association with such 
specific infectious processes as scarlet fever and diphtheria. In the 
latter diseases under these circumstances there is, of course, a double 
infection. While the theoretical basis upon which the use of this 
serum rests is quite as good as that of antitoxic serum for diphtheria, 
the results from its use have not been so valuable, probably because 
in many instances the infectious process has not been solely due to this 
micro-organism and the other disease organisms have produced their 
effects uninfluenced by the serum used. The best results have been 
obtained from its use in puerperal and post-traumatic sepsis, but only 
in the presence of well-marked and positive streptococcic infection 
would the writer resort to it. Its method of employment is identical 
with that of diphtheria antitoxin. Care should be taken to obtain 
the serum from a reliable manufacturer. It would seem probable 
that in some cases of ulcerative endocarditis this serum is the best 
treatment that can be used. The dose of this serum is usually 10 
to 20 c.c. every twelve hours, according to the age of the patient 
and the severity of the infection. 

CLIMATIC TREATMENT. 

(See Springs and Climates.) 



COLD AS A RE MED Y. 471 



COLD AS A REMEDY. 



Cold, or the rapid abstraction of heat, is a remedial measure that 
is nearly always available, and is possessed of very great power 
for good in properly selected cases. At the very first we may divide 
its use into its local application, for a superficial, limited, deep-seated, 
or distant influence, and its general application for the purpose of 
affecting the entire body. 

When cold is applied for its limited and local action, it is always 
used with two objects in view — namely, to cause localized contraction 
of bloodvessels which through inflammation are engorged so that the 
parts are reddened and swollen, or temporarily to anaesthetize or 
benumb a nerve- fibre for the immediate relief of pain, and with the 
hope that the temporary paralysis may ultimately result in such nerve- 
changes as to produce a cure. 

For these reasons cold, in some form, is a popular remedy for a 
burn or sprain or any injury likely to be followed by inflammatory 
processes. In some cases, it is true, hot water or dry heat is equally 
efficacious, and this fact will be referred to when speaking of heat. 
(See Heat.) It may, however, be stated, as an almost invariable rule, 
that the choice of heat or cold is to be governed by the sensations 
of the patient, who will generally assert that one of the two is the more 
agreeable. 

Cold or heat causes relief of pain in inflammation by producing con- 
traction of the local bloodvessel walls. As a result, inflammatory exu- 
dates do not occur, congestion is relieved, and as the pressure on the 
nerve-filaments ceases the pulsating pain of inflammation passes away. 

A very useful remedy for the sprain of an ankle when it is a recent 
accident is to let the patient sit with the foot elevated, with a cloth 
wrung out in ice- water or an ice-bag applied over the part affected. 

In the treatment of localized pain or inflammation cold is used in 
a number of ways, largely depending in their choice on the will of 
the physician and the means of the patient. The simplest, cheapest, 
and perhaps the most efficient method of using cold is to place cracked 
ice in a pig's or sheep's bladder or rubber bag, and, after tying the 
neck to prevent leakage, to lay it over the inflamed part, surrounding 
it with a towel, so as to prevent the moisture, which appears on the 
surface from condensation, from wetting the clothing. 

Where a very limited and comparatively transient effect is needed, 
chiefly for anaesthetic purposes, it is customary in hospital and private 
practice to use a piece of ice sprinkled with a little fine salt, and held 
against the skin by means of a towel in the hands of the physician. 
Actual freezing can often be produced very rapidly in this manner. 
Where a more rapid method is desired, sprays of various very volatile 
liquids may be driven against the part by an atomizer. Probably the 
most readily employed of these liquids is ether, which is fairly effective 
if it is used in a fine spray and driven against the skin in such a way 



472 REMEDIAL MEASURES OTHER THAN DRUGS. 

as to favor rapid evaporation. Another of these agents is rhigolene, 
which is one of the lightest and most volatile of the liquid products of 
coal-tar, and is used in a spray from an atomizer in the same manner 
as is ether. Chloride of ethyl is a liquid used as a substitute for rhigo- 
lene as a local anaesthetic through the intense cold produced by its 
evaporation. The fluid is directed against the skin over the involved 
area by means of a nozzle attached to the cylinder containing it. (See 
Ethyl and Methyl Chloride.) 

It is hardly necessary for the writer to repeat that, as the last three 
liquids are very inflammable, they should not be used near a light or 
fire. 

Aside from the local effects of cold on inflammatory processes, it is 
largely resorted to for the relief of neuralgia of a superficial type, 
and has often been used for the cure of deep-seated neuralgias, as over 
the course of the sciatic nerve in sciatica. Generally, however, it is 
employed in neuralgia of the supraorbital nerve, where, owing to the 
superficial position of these fibres, the cold can readily reach them. 
The skin should be distinctly whitened and blanched, and even hard- 
ened, by the cold before its application is stopped, and if one applica- 
tion does not cause a cure, it may be repeated every day for several 
weeks in obstinate cases. Sometimes cold is used to benumb the skin 
or subcutaneous tissues in cases where a minor surgical operation is to 
be performed, but the pain of freezing an inflamed part is as great 
as that of the operation itself without an anaesthetic. Freezing is 
valuable when the physician is using the actual cautery, and in all 
these cases may be employed as is indicated above. 

The local employment of cold for the influencing of deeply seated 
organs is a well-recognized therapeutic measure of great practical and 
physiological interest, and is closely associated with the subject of 
counterirritation. (See Counterirritation.) According to Winter- 
nitz, cold applied to the feet affects the cerebral circulation, cold to 
the thighs the circulation in the lungs, and cold to the back the cir- 
culation around about the pituitary region. That these conclusions 
are true is not positively known, but the fact that Winternitz has 
reached them by a series of experimental studies indicates their cor- 
rectness to a great extent, and they also find additional support in 
the popular and medical confidence in the use of cold to the head and 
heat to the feet in cerebral affections. 

Practically, cold has been employed with no small degree of suc- 
cess in the treatment of pneumonia and pleurisy in the form of the 
ice-poultice or ice-jacket or the ice-coil. (Fig. 57.) The only thing 
needful for such treatment is a condition of strength on the part of the 
patient, for it should not be used in adynamic cases, as feeble patients 
cannot stand the abstraction of so much heat from their bodies. When 
the ice-poultice is used, it is made by taking a mass of finely chopped 
ice, draining it of all water, and mixing it thoroughly with dry saw- 
dust in sufficient quantity to absorb all the water derived from the 



COLD AS A REMEDY. 473 

ice as it melts. The mass is then basted into a quilt, so arranged that 
all of the contents will not sag to the lower border, and wrapped around 
the chest. With this plan it is difficult to avoid wetting the clothing. 
Cold has also been highly recommended when used in pneumonia in 
another manner, and by no less an authority than Niemeyer, who 
speaks of it as follows: 

"I have made extensive employment of cold in the treatment of 
pneumonia, and, relying upon a large number of very favorable results, 
can recommend this procedure. In all cases I cover the chest of 
the patient, and the affected side in particular, with cloths which 
have been dipped in cold water and wrung out. The compresses 
must be reapplied every five minutes. Unpleasant as this procedure 
is in almost all cases, yet even after a few hours the patients assure 

Fig. 57. 




Showing the application of the cold-water coil to the chest in croupous pneumonia or pleurisy. 
Applied to the left side, it may be so used in pericarditis in place of the ice-bag. By suction on 
the lower end of the tubing a stream of water flows from one bucket to the other, and when the 
water has been transferred the stream may be reversed by changing the level of the buckets. 

me that they feel a material relief. The pain, the dyspnoea, and often 
the frequency of the pulse are reduced. Sometimes the temperature 
goes down an entire degree. My patients often retain this surpris- 
ing condition of improvement throughout the entire duration of the 
attack, so that their outward symptoms would hardly lead one to 
imagine the grave internal disorder. The relatives of the patient, 
too, who do not fail to perceive the improvement, now readily assist 
in the treatment to which at first they were opposed. In a few cases, 
and only in a few, the use of cold affords no relief, and the trouble- 
some manipulation for its application increases the distress of the suf- 
ferers so much that they refuse to keep it up. In such cases I have 
not insisted upon the further application of cold.' 1 

In endocarditis, and especially in pericarditis, the use of an ice-bag 
placed over the heart is a valuable remedial procedure, for it relieves 



474 



REMEDIAL MEASURES OTHER THAN DRUGS. 



palpitation and quiets the heart, decreases the pain and diminishes 
the inflammation. It is also useful for cardiac palpitation and for 
the rapidly acting heart of fever during the course of pneumonia or 
typhoid fever. 

Cold affusions to the head, and, better still, the use of an ice-bag, 
have long been highly regarded in the treatment of meningitis and head 
injuries; and a hot bottle to the feet and cold to the head will often 
induce sleep in persons who habitually suffer from insomnia. This is 
particularly the case with those individuals who are wakeful from 
mental overwork. On the other hand, cases with insomnia from cere- 
bral anaemia do well if a cold plunge-bath is taken before going to 
bed, although in still other cases a hot bath is more efficacious. (See 
Heat.) The latter instances are not due to anaemia, but to nervous 
irritability, which the heat quiets, whereas the insomnia of cerebral 
angemia is relieved by a cold plunge by reason of the increased circu- 



FlG. 58. 




Showing the application of the cold-water coil to the head in cerebral congestion, headache, 
meningitis, and in fevers. 



latory activitv and equal distribution of the blood produced by the 
bath. (Fig. 58.) 

When cold is to be applied to the head continuously, it is often 
convenient to employ a coil made of rubber tubing and so shaped as 
to fit the vertex. One end of the tubing should reach to a tub of 
cold water on one side of the bed and the other to an empty tub on 
the other side. By sucking on one tube siphonage is established, 
and as soon as the liquid has been transferred from one tub the 
full tub is raised, the stream is reversed, and the water passes back 
to its former receptacle. 

Cold water dashed or sopped against the perineum or the scrotum 
and the lumbar region is a favorite remedy with some practitioners 
for nocturnal seminal emissions, and the scrotum may be submerged 



COLD AS A REMEDY. 475 

in a tumbler of cold water for a few minutes at night for a similar 
purpose. 

A very useful treatment of dysentery is to inject gently into the 
rectum about one or two quarts of cold water — if necessary it may be 
ice cold; and a similar application for piles is a useful adjunct to all 
forms of treatment for these troublesome formations. So highly do 
some physicians praise this method that the writer has thought it 
proper to quote from a paper of J. William White upon this subject. 
He says: 

"I desire to call the attention of the profession to a method of 
treatment which, although not altogether new, is yet not appreciated 
as, in my judgment, it should be. I refer to a moderately forcible 
stream of water of varying temperature in the treatment of a number 
of affections of the rectum, anus, and genito-urinary apparatus. The 
tonic and astringent effect of such a stream of water upon any living 
tissue is, of course, a well-understood fact, and has been employed in 
the arrest of hemorrhage, in the treatment of inflammation, and in 
various conditions. But it has only been in exceptional cases, and 
usually by the aid of more or less troublesome apparatus, that it has 
been used in the class of cases to which I now refer. 

"The bidet, as I have now for a few years prescribed it, should be 
of the variety which can be attached to the water-closet seat habitually 
used by the patient. It should have a nozzle capable of throwing 
a stream of about the calibre of an ordinary lead-pencil or a little 
less. The head of water should be sufficient to make it impinge upon 
the parts exposed to it with enough force to excite there a little sensa- 
tion of smarting or tingling. That degree of force will, for example, 
be sufficient to enable the patient to take an enema, or, if a female, 
to take a vaginal injection. The bidet pipe should be movable by 
means of a handle, so that the stream can be directed against any 
portion of the external genitals, the perineum, the anus, or the sur- 
rounding parts. It should also have connection with the hot and 
cold water-supply of the house, so that the water may be used of any 
temperature which the physician may prescribe or which the sensa- 
tions of the patient may make desirable. Stopcocks should regulate 
the size and force of the stream, and should be so placed as to be 
easily reached by the hand of the individual sitting upon the water- 
closet seat. Such an apparatus can be put in place by any experienced 
plumber in any ordinary water-closet at an expense of from fifteen to 
twenty dollars, and, in Philadelphia at least, the usual head of water 
obtainable even in third-story rooms is quite sufficient for all thera- 
peutic purposes. 

"The diseases in which it may be desirable to use this method of 
treatment may be divided into two classes: First, those affecting the 
lower end of the bowel and its outlet; second, those involving the 
genito-urinary system. Among the first the most important are hem- 
orrhoids, internal and external; prolapsus ani, and slight cases of 



476 REMEDIAL MEASURES OTHER THAN DRUGS. 

prolapsus recti; pruritus ani and eczema of the margin of the anus 
should also be included in this group of cases, in which it has now 
for some time been my habit to prescribe the systematic employment, 
twice daily, of the bidet, once immediately after the daily stool, and 
for the second time, by preference, just before going to bed. As a 
rule, in all the midwinter months the ordinary temperature of the 
Schuylkill water is that to be preferred, although I am largely gov- 
erned by the feelings of the patient in this respect. An enema should 
be taken at each of these times, the lower portion of the rectum being 
thus thoroughly washed out at least twice daily, after which the stream 
of water is allowed to play upon the affected region for a period of 
from five to fifteen minutes. The ordinary and useful effect of cool 
sponging or washing immediately after stool in cases of hemorrhoids 
is by this means enormously increased. Internal hemorrhoids will, 
under this treatment, in many cases almost entirely disappear unless 
they are exceedingly large and have been frequently inflamed or 
strangulated and badly neglected; external hemorrhoids, even when 
fleshy, will shrivel and become scarcely noticeable. 

"Perhaps nothing is more distressing among minor affections than 
the trouble described as pruritus ani, and variously attributed to liver 
disease, constipation, gastric troubles, latent gout, uterine disease, 
parasites, neuroses, and a number of other causes, varying from eat- 
ing of shell-fish or excessive smoking to alleged hereditary predis- 
position. There are very few practitioners of any experience who 
have not discovered how difficult it is in any particular case of pru- 
ritus to assign distinctly the annoying symptoms to any one of these 
causes. Often the whole list may be carefully gone through and 
eliminated, or the proper remedies may be applied successively, as 
different theories are adopted, without the slightest benefit resulting. 
Ointments, lotions, and ordinary cool bathing will be tried in great 
variety, but without avail, and such patients will often go from one 
physician to another or fall into the hands of quacks while seeking 
proper professional relief. My list of cases of this character which I 
have now treated by means of the 'bidet' comprises eight. 

"My second class of cases includes, chiefly, certain prostatic troubles, 
varicocele, atonic impotence in the male, and pruritus of the vulva 
or vaginitis in the female. In case of varicocele, although I have 
not succeeded in effecting a cure in any instance by this method, I 
have certainly seen advancing enlargements of the spermatic veins 
becoming stationary, long relaxed and pendulous scrotums become 
firm and much smaller, and the mental condition of the patient, which 
is so important an element in many of these cases, shares in the improve- 
ment. In chronic prostatitis, a most intractable and distressing ailment 
in many instances, it has come to be a part of my routine treatment 
to order the use of cold perineal douches by means of the bidet, asso- 
ciated with frequent cold enemata given in the same manner; ancTT" 
believe to-day that if I had to discard all therapeutic measures but 



COLD AS A REMEDY. 477 

one in these cases, I would retain this one. In a certain number of 
cases of impotence associated with general muscular weakness, loss 
of tone, lack of general strength and vitality, accompanied by imper- 
fect or rapidly subsiding erections, I have found that the cold douche 
applied with some force and for considerable lengths of time to the 
perineum and testicles has been productive of marked benefit." 

The use of a cold bath for the purpose of increasing the tone of 
the system is as old a custom as any which we have, but, like all other 
things in medicine, cannot be used without distinct indications for its 
employment, or, to speak more correctly, the absence of certain con- 
traindications. The most universal exception to its use which we find 
is that class of persons with whom prolonged bathing of any kind, par- 
ticularly when it is frequently repeated, does not agree. The writer 
is sure that a much larger number of persons belong to this class than 
is generally recognized, and he has seen cases of nervous exhaustion 
and general loss of vivacity and vitality occur as a result of too fre- 
quent bathing. This is the case more especially with daily bathers 
who soak themselves in hot or warm fresh water, particularly if the 
bath be taken in the morning. 

Before passing on to the consideration of the physiological action 
of a bath, and why and when a bath should be used, it is proper to call 
attention to the fact that a very large proportion of children who are 
bathed daily are allowed to lie and soak in the tub, and as a result 
become debilitated and fretful, only to recover when the bath is used 
once or twice a week, and replaced in the interval by a nightly sponging 
with salt and whiskey or salt and water. 

Through practical experience and much experimental research of 
a reliable character we now know that the following phenomena accom- 
pany the use of a cold bath in a healthy person with whom such a bath 
agrees : 

On entering the water he shivers, thinks it almost unbearably cold, 
and he gasps if the cold suddenly touches the belly- wall or an equally 
sensitive surface. In a moment, however, reaction sets in, and the 
extremities, heretofore trembling and covered with cutis anserina, 
become warmer and flushed. The pulse is increased in force and 
frequency, and the respirations are deeper and more thoroughly per- 
formed. As a result of this each portion of the body receives a more 
perfect supply of blood and feels rejuvenated. Following this stage 
of exhilaration, a third stage comes on, in which the chilliness and 
depression of the first stage recur in an exaggerated degree, but this 
condition does not ensue unless the person remains too long in the 
water. If he leaves the bath while in the acme of exhilaration, the 
stimulus may remain with him throughout the rest of the day. 

The reason for the occurrence of this train of symptoms is not far 
to seek. The chilliness of the first stage shows that the great abstrac- 
tion of heat is lowering the bodily temperature, the centres for calori- 
fication in the body not producing sufficient heat for the preservation 



478 REMEDIAL MEASURES OTHER THAN DRUGS. 

of the normal temperature. At first the cold drives the blood into 
the warm recesses of the body, leaving the surface cold; but in a 
few moments the system is aroused to the recognition of the fact that 
it must increase its exertions in the propulsion of blood and manu- 
facture of heat, and so with an effort it puts forth all its power, picks 
up each corpuscle in the internal organs that is hiding from the cold, 
and, after imbuing it with warmth obtained by increased heat-produc- 
tion in the sources of heat-manufacture, forces it out to the surface 
of the body along with its fellows, which are driven to all parts of the 
system. This is not a mere figurative way of putting the matter, for 
cold always contracts bloodvessels and reflexly stimulates the vital 
centres to increased activity. 

When the bath is too prolonged, the result of overstimulation ensues, 
and the depression of the nervous system and circulation may be suffi- 
cient to interfere greatly with normal functional activity. 

Just at this point it becomes clear why persons " catch cold," or, 
technically speaking, suffer from local or general congestions. An 
individual who is weak may never reach the stage of stimulation just 
spoken of, because his system has not enough units of force in it to 
expend them upon the functional activities named, and, as a consequence, 
the blood, which at the first shock has hurried into the internal viscera, 
is not driven back to its duty, but, sulking in its retreat like a deserting 
soldier, allows disaster and disease to ensue because its superior officer, 
the central nervous system, cannot gather together enough force or 
authority to make it do its duty. These cases present evidences, there- 
fore, of circulatory and systemic depression or have congestion of the 
lungs, liver, or other parts. In the strong person exactly the same 
state of affairs obtains in the tired stage of depression, but only after 
the strength of the system has been expended in the activity of the 
stage of exhilaration. 

Cold salt baths, particularly if they are sea baths, are more stimu- 
lating and not so relaxing as is fresh-water bathing. 

The use of a cold bath after a person becomes heated ls popularly 
supposed to be dangerous. On the contrary, every athlete knows 
that nothing is so refreshing and so preventive of muscular stiffness 
after severe exercise and sweating as a cold plunge- or shower-bath; 
but he also recognizes the fact that a plunge is all that is permissible, 
and it is only the person who possesses the healthy circulatory power 
which will enable him to rebound from momentary depression to 
increased activity that should resort to such procedures. 

The tonic effect of the so-called drip-sheet in certain neurasthenic 
cases is most marked. As has been pointed out, reaction must be pro- 
duced, since it is by the stimulation of the circulation and its readjust- 
ment or equalization that good is achieved. The duration of the use of 
the drip-sheet and the temperature of the water in which it is wrung 
out are governed by the ability of the patient to react. Very feeble 
patients must be gradually trained by moderate means to the colder 



COT.Ty AS A REMEDY. 



479 



temperatures, and, if need be, may stand in a tub containing a few 
inches of warm water if there is a tendency to coldness of the feet. 
The patient being stripped, the nurse takes a linen sheet previously 
dipped in water at any temperature that is not too low for reaction 
to take place, and throws it around the patient's body and over the 
head, so that in a moment the entire surface is in contact with it. 

Fig. 59. 




Drip-sheet wrung out and thrown about the patient, who rubs himself in front while the 
attendant applies friction to the back of the body and limbs. 

Then the nurse applies brisk friction all over the patient's body 
and limbs, while the latter rubs the front of the body with his own 
hands. The whole performance is over in a few moments, and the 
patient should then lie down, be lightly covered, and rest. Such a drip- 
sheet will often be a cure for insomnia depending upon faulty cerebral 
circulation or nervous tension. In other instances it seems to be stimu- 



480 REMEDIAL MEASURES OTHER THAN DRUGS. 

lating, and to arouse dormant functions. Once a day is usually 
sufficiently often to use it, and when treating neurasthenics the 
morning is the best time to employ it unless it is designed to cause 
sleep. (Fig. 59.) 

Cold in Fevers. 

The proper manner to employ cold water in fever should be 
thoroughly understood. It may be used at varying temperatures, 
according to the effect desired, such as cool, moderately cold, and very 
cold. 

Very commonly in the course of a fever the patient is restless, 
uncomfortable, and sleepless, yet has not a temperature fraught 
with harm. Such a case may be sponged with tepid water or with 
alcohol and water, or salt and whiskey, with great benefit in the pro- 
duction of sleep, the reduction of fever, and the advantage of nervous 
quiet. Sometimes the sponging is successful when used only over 
the arms and legs, but more frequently it should be extended at least 
to the spinal column. 

If tepid sponging does not lower the fever in a given case, then 
ordinary cool tap- water should be employed ; and it is well to remem- 
ber that the secret of successful sponging lies in the use of a sponge 
not saturated to overflowing, but only sufficiently wet to leave a thin 
film of moisture on the skin, which cools the patient by its rapid evapo- 
ration and does not wet the bed-clothes. 

When we come to a study of the use of cold water in prolonged and 
severe fevers we find that its use is now universally recognized as the 
proper treatment, and with good reason. At one time it was believed 
that all the good results from cold bathing were due to the reduction of 
the fever, but it is now known that this is the least important effect of 
the bath except when there is such a hyperpyrexia that there is danger 
from that source. The benefit derived from the external use of cold 
water in infectious fevers rests upon the stimulation of the vasomotor 
system and general circulation, so that local stasis or congestions of 
blood do not occur in vital organs, in the stimulation of the processes 
of oxidation and nutrition, and in the elimination from the body by 
the skin and kidneys of toxic materials. Further, the more frequent 
cleansing of the skin aids its normal function, prevents chafing and 
bed-sores, and lowers the temperature by aiding in the dissipation of 
heat directly and through the sweat, which, even if imperceptible, is 
an important factor in reducing body-heat. 

Whenever cold is used for the reduction of fever and applied to the 
entire body, it should be applied rapidly and be accompanied by active 
rubbing of the skin of the entire body to bring the hot blood to the sur- 
face and to gain the valued effects of massage. As a rule, the water 
should be used at one temperature, and better results will be obtained 
if it is cold enough to produce something of a shock to the circulation 
and nervous system, for the effect sought is the production of a 



COLD AS A REMEDY. 481 

" reaction " — that is, a redistribution of the blood and an awakening 
of all the vital processes. For this reason the writer does not approve 
of graduated baths — that is, the use of water which is gradually cooled 
while the patient is being bathed. The whole idea of the cold-bath 
treatment of fever is to produce the reactive stimulating effect sought 
by the well man who takes a sea bath. Consequently individuals too 
feeble to react should be bathed in slightly cooled water at first, and 
the temperature reduced each day a few degrees until it is quite cold. 
The exact degree of cold depends upon the need of the patient as 
stated below. 

Fever is then to be reduced by cool sponging, in old and feeble 
patients using water at 90°, 80°, or 70° F., according to the ability to 
react and the needs of the patient. Friction is to be used with one 
hand while the sponging is done with the other. 

If the patient is young enough and sufficiently strong to react, then 
the water used should be from 70° to 32° F., according to the needs 
of the case; and if the fever is persistent and difficult of reduction, 
the nurse may rub a piece of ice over the skin rapidly, applying friction 
constantly with the other hand. 

The patient should always be stripped and laid on a blanket spread 
over a rubber sheet which has been placed to protect the bed. 

It is essential when sponging is used that more of it be applied 
to the back than the front of the body, for at the back the great muscles 
and thick skin retain the heat, and these parts are not cooled if only 
the front of the body is sponged. Further, the posterior surfaces are 
the ones apt to be congested and sore from the dorsal decubitus, and 
therefore need the stimulant effect of the bath, as do the kidneys and 
other deeply situated organs. That this treatment is of value in those 
who react is shown by the marked redness of the skin, the improvement 
of the circulation and respiration, and the cleared mind. 

The use of the ice-rub with a piece of ice weighing about two 
pounds held in the nurse's hand requires more care than does the 
immersion bath, but I have yet to see the case of typhoid fever, after 
the first week, in which this plan fails to reduce the temperature if it 
is properly employed. Indeed, I have learned that when this method 
fails it is because the nurse does not know how to use it. The rubbing 
with the ice and with the other hand must be brisk and produce re- 
action. 

In some cases where sponging is not efficient the patient may be 
placed on a small canvas cot placed by the side of the bed and covered 
by a large rubber cloth, which, by being; raised at the head and 
depressed at the foot, forms a channel for the water. Over this, again, 
is placed an ordinary sheet. The patient, after being stripped, is 
laid upon this sheet, which is then folded over him, and a spray from 
an ordinary watering-pot for flowers allowed to play upon his body 
from head to feet. The temperature of the water depends upon the 
effect required. The bed should be so arranged that the water will not 

31 



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484 REMEDIAL MEASURES OTHER THAN DRUGS. 

remain in puddles under the patient, but drain off into a bucket at 
the foot. The sheet being wet allows evaporation to go on, and a 
rapid fall in the fever results. It is of the greatest importance that 
the attendant lightly but briskly rub the patient all over with the 
hands, so as to bring the blood to the surface and prevent internal 
congestions. 

If the fever cannot be reduced to 101° F. by the methods of bathing 
just detailed, the patient should be subjected to the cold plunge 
or tubbing, the so-called "Brand bath," which has been employed 
almost exclusively in typhoid fever. The chief object sought by its use 
has already been described in discussing the effect of sponging. This 
object is reaction. 

The method consists in immersing the patient every three hours, if 
his temperature reaches 102° or 102.5° F., in a bath-tub of water at 
70° F. and allowing him to remain there under friction for fifteen or 
twenty minutes, or until his temperature is reduced to 101° or 100° F. 
Before the patient enters the tub he is often given \ to 1 ounce (15.0- 
30.0) of whiskey in a little milk or water to prevent depression. The 

Fig. 61. 




Bath stretcher. (F. E. Hare.) 

patient will generally complain bitterly of the cold, particularly at first, 
and will also appear blue and chilly after the bath, but these signs are 
not so dangerous as they are alarming. If there be persistent and 
prolonged coldness, then hot bottles may be applied to the feet and a 
little whiskey or brandy given. During all kinds of bathing an 
ice-bag should be kept to the head to prevent cerebral congestion. 

When the tub is used, it should always be placed near the patient's 
bed, so as to avoid unnecessary disturbance and mental excitement, 
for his strength must be conserved. 

In using the Brand bath, a patient should be lifted with care and 
gentleness from the bed to the tub. The water in the tub should be 
deep enough nearly to cover his body, and yet not so deep as to float 
him in the tub so that he feels uncertain of his position and has contin- 
ually to exert himself to keep his head above water. The lifting of a 
full-grown man into a tub, unless some mechanical aid is employed, 
requires several assistants, and, even when they are present, is very 
often a strain not only upon the nurses, particularly if a number of 
patients have to be bathed, but upon the patient as well. It is very 
important that patients should not exhaust themselves by making 



COLD AS A BEMED Y. 



485 



efforts under these circumstances. A number of devices have been 
invented for the transfer of the patient from the bed to the bath. 
Probably the simplest and best is that employed by F. E. Hare, of 



Fig. 62. 




The use of F. E. Hare's bath stretcher. First stage. 
Fig. 63. 




The use of F. E. Hare's bath stretcher. Second stage. 

Brisbane, Australia, as it is inexpensive, and can be employed by two 
persons unless the patient is unusually heavy. It consists, as shown in 
the accompanying figures, in a perforated board, from which the water 



486 



REMEDIAL MEASURES OTHER THAN DRUGS. 



readily drains when the patient is lifted from the bath. This board 
has a loose piece at the top, which by resting on the head of the tub 
prevents the patient's face from being immersed. A rubber sheet 
having been placed on the bed by the side of the patient, the board 
is laid on top of it, and the patient is then readily slid by a lateral 
movement on to the board, lifted up, and immersed in the tub. After 
the bath is over, the board is lifted, with the patient upon it, as high 
as the edge of the tub, a loose piece of board is slipped transversely 



Fig. 64. 




The use of F. E. Hare's bath stretcher. Third stage. 

across the foot of the tub, and on this and on the head of the tub rests 
the board upon which the patient is lying. In a few moments the 
excess of water drains off into the tub, and the board is then lifted on 
to the patient's bed, which is still protected by the rubber sheet. The 
patient is then slid off from the board on to the bedding and the neces- 
sary handling is completed. 

When a patient comes under observation as late as the third week 
of typhoid fever the cold bath is contraindicated, as a rule, because 
the patient does not react owing to his feebleness. If the bath is 
used from the beginning of the illness, it may be used all through the 
attack, as the system is then trained to react and is rarely so asthenic. 
Other contraindications are intestinal hemorrhage, nephritis, and great 
cardiac feebleness, but pneumonia is thought not to be a contrain- 
dication. With this view the writer disagrees unless the pneumonia 
be due to stasis and asthenic congestion. 1 

i For a careful resume of the " Real Value of the Brand Bath in Typhoid Fever," by the 
author and Dr. C. A. Holder, see the Therapeutic Gazette, March 15, 1898. 



COLD AS A REMEDY. 



487 



The fever of enteric fever does not readily yield under the use of the 
bath in the first days of its course, whereas that of other maladies does 
do so. This is an important differential point. 

All cases of typhoid fever should receive the cleansing and reactive 
effects of sponging and rubbing at least once a day, even if the fever 
is not sufficiently high to need reduction. 

Whenever cold is used in febrile cases a thermometer should be 
placed in the mouth or pushed deeply into the rectum, and the fall in 
the temperature watched. As soon as it reaches 101° or 100° F. the 
bath must cease, lest the fall continue, reaction fail, and collapse ensue. 



Fig. 65. 




The use of F. E. Hare's bath stretcher. Fourth stage. 



On the removal of the patient the surface should be gently dried 
with towels, and the bed-clothing consist of only a sheet, or a sheet 
and one blanket in cold weather. Above all things, it must be remem- 
bered that the patient is not to be wrapped in a blanket, and not 
only this, but that he must not be placed in a blanket while still in a 
wet sheet. 

The wet sheet, if surrounded by a blanket, soon places the patient 
in a typical Russian or warm moist bath, calculated to raise instead 
of lower the fever. 

Where sunstroke (thermic fever) is present the patient may have 
ice rubbed over his body or be put directly into a bath-tub of ice- 
water; but in any event the attendants must rub the patient's skin to 
bring the hot blood to the surface and prevent congestions. Cold 



488 REMEDIAL MEASURES OTHER THAN DRUGS. 

water may also be injected into the bowel in cases where the skin is 
cold but the central temperature very high. (See Enteroclysis.) 

The treatment of rheumatic hyperpyrexia by cold is quite as suit- 
able as is this treatment of other fevers when the hyperpyrexia is so 
excessive as to endanger life. 

Baruch, the apostle of hydrotherapy, has recently expressed some 
views in the following emphatic "Dont's," with which the author most 
heartily agrees : 

Don't bathe with cold water to reduce temperature, but to refresh 
the fever-stricken patient. 

Don't permit cyanosis or chattering of teeth; stop! 

Don't stop bathing because patient complains of chilliness, unless 
the teeth chatter. 

Don't raise bath temperature on the latter account; shorten bath 
and increase friction. 

Don't neglect friction during every cold procedure; it prevents 
chilling. 

Don't disregard the well-ascertained fact that the Brand bath (of 
65° to 70° F. every three hours when awake, with active friction) is the 
ideal bath for typhoid fever only. 

Don't give up cold bathing because the ideal bath is not obtainable; 
other procedures are useful. 

Don't use the ice-coil to the abdomen; it has no refreshing effect 
and renders the skin beneath it cyanotic. 

Don't lose sight of the fact that the chief aim of all cold procedures 
is reaction. 

CO-ORDINATED MOVEMENTS FOR TREATING LOCOMOTOR 
ATAXIA AND MYELITIS. 

This plan of treatment is based upon the fact that great improve- 
ment in locomotion on the part of ataxic patients can be produced by 
causing the patient to make certain definite movements, the object of 
which is to re-educate his co-ordinating power. The power of co- 
ordination is lost partly by reason of the disease in the nerves and 
spinal cord, and partly because the patient has become bedridden, 
so that his otherwise healthy tissues waste from disuse. Definite 
exercises in such cases perhaps train collateral nerve-centres and 
nerve- tracts to do work not usually part of their function. In any 
event, such patients often greatly improve under this procedure. 

It is vitally important that the various movements should be made 
slowly and with as great nicety as possible. 

Exercises for the Lower Limbs. — The patient lies on his back on 
a firm couch and slowly lifts his fully extended leg until he touches 
with his toes the finger of an attendant, who holds his hand at a dis- 
tance of from eighteen inches to two feet above the bed. These exer- 
cises should be repeated several times with each leg. 



LOCOMOTOR ATAXIA AND MYELITIS. 



489 



Next, the patient completely flexes the leg on the thigh, and then 
the thigh on the abdomen. After this the limb is slowly extended 
until the toe once more touches the finger of the attendant, the leg 
being elevated at the same time that it is extended. After making 
this contact the extended limb is slowly lowered till it rests on the bed. 

A third exercise consists in having a board made with pigeon-holes 
attached to it, the tops of the pigeon-holes being taken off. A dozen 
of these holes should be made, and either lettered in the order of the 
alphabet or numbered consecutively. The patient lying on the back, 
with the heels resting in two of these pigeon-holes, is directed to 
raise a leg and to lower it so that the right heel will come down in the 
pigeon-hole named by the attendant; so that if the right heel is resting 
in pigeon-hole 1, it may be placed in pigeon-hole 4; and afterward 
the left heel, which may be resting in pigeon-hole 7, is placed in pigeon- 
hole 6. It will be readily seen that following these directions trains 
the co-ordinative faculty. The edges of the pigeon-holes should be 
smooth, and perhaps padded, to prevent the heel from being injured 
by striking against them. 

Fig. 66. 



mmm„ 




Showing the pigeon-holes into which the patient puts his heels when training his co-ordination 
and muscle-sense in locomotor ataxia. 



The Standing Exercises consist in endeavoring to stand with the 
eyes closed and the feet close together, and in trying to stand on one 
foot with the eyes open or closed. 

Another exercise is to paint a black stripe a foot wide across the 
floor of a room, and to direct the patient to walk along this stripe with 
or without support, being careful to keep his feet within its limits. 
He will usually do better with bare feet than if he has his shoes on. 
In taking this exercise the patient should be directed to bring the 
foot down in the natural position, and not upon the heel, as is so 
commonly done by tabetics; and also he must not evert the toes too 
much in walking, as is so commonly the habit. As the patient 
improves, the stripe upon which he walks may be narrowed. 

The next walking exercise consists in going up and down stairs. 
It is well to build a flight of stairs, consisting of five or six steps, with a 
platform, which is so securely built that there is no danger of a fall. 
A balustrade or railing is put on each side of the steps for lateral sup- 
port, and the patient is then made to ascend and descend the steps. 
Care must be taken that he mounts the successive steps by a proper 
contraction of his quadriceps rather than by pulling himself up by the 
aid of his hands. Many tabetics simply place the leg in a rigid position, 
and then use their arms to elevate themselves to the next step. 

Still another exercise is to place the patient in an arm-chair and 



490 REMEDIAL MEASURES OTHER THAN DRUGS. 

teach him to lower himself into the chair without touching the arms of 
the chair with the hands. 

It is vitally important that these exercises shall not be continued 
until the patient is unduly fatigued. He should simply be slightly tired 
at the most, and usually a quarter of an hour, twice or thrice a day, 
is a sufficient length of time for the treatment. Exhaustion is dis- 
tinctly harmful under these circumstances. The patient should be 
urged to respond promptly to directions, as alacrity is important in 
training the co-ordinative faculties. 

Somewhat similar exercises may be devised for the arms in cases 
where the upper limbs are ataxic as well as the lower. ones. 

COUNTERIRRITATION. 

Counterirritation is a term applied to the use of substances irri- 
tating to the surface with which they come in contact, and is employed 
for the purpose of influencing morbid processes in more or less dis- 
tant parts or of affecting the general system. It has been thought 
that this method savors of the doctrine of "like cures like/' but in 
reality it is based on sound physiological laws, and is so logical as to 
have been described by the founder of homoeopathy as useless. 

The entire basis for the employment of counterirritation rests 
upon reflex action, or the conduction of a nervous impulse to a centre, 
which, when so stimulated, sends out an impulse to the part of the 
body which is diseased. 

The use of counterirritation may be divided into four parts or pur- 
poses: the first is for affecting inflammations or congestions; the 
second, for causing the absorption or removal of inflammatory deposits 
after true inflammation has ceased; while the third purpose is for 
the relief of pain; and the fourth for the effect which can be exercised 
upon the general system by blisters in systemic disease. 

In the same manner that we can divide the indications for counter- 
irritation into four parts, so can we also divide its forms into three 
varieties according to their severity. The most severe are the caustics 
or escharotics, the next the epispastics or blisters, and finally the 
rubefacients or reddeners. 

The proper manner of employing a counterirritant to affect inflam- 
mations is not to apply it directly to an actually inflamed area, but a 
little to one side of it or at a spot known to be connected intimately 
with the diseased area by nerve-fibres. 

Thus, it is well known that in diseases of the eye the blister should 
be applied back of the ear, and that in abdominal neuralgia or in 
pleurodynia the best results are reached, not from the application of a 
blister to the spot where the pain is felt, but to the point upon the 
vertebral column where the nerve at fault takes its exit. The reason 
for this is that pain is always referred to the peripheral end of an irri- 
tated nerve, and pleurodynia or abdominal pain often arises from verte- 



CO UNTERIRRITA TIOK 



491 



bral disease or inflammation about the spinal ligaments or the foramina 
of exit for the nerves. In a similar manner we sometimes apply a 
blister, in the early stages of hip disease, not to the knee or ankle, 
where the pain is felt, but at the seat of the trouble — namely, the hip. 
Counterirritation is contraindicated by the presence of any acute 
inflammation directly under the spot where it is proposed to place a 
blister; that is, if any reddening of the skin is present, the blister or 
other form of irritation must not be applied there. If used at all, it 



Fig. 




/ 




Showing the areas in which blisters are to be placed : P, pericarditis; A, appendicitis; 
L, laryngitis; V, vomiting or gastritis; P L, pleuritis; E, inflammation in joint. 



must be some little distance away, or a series of small flying blisters 
should be placed around the inflamed zone. A flying blister is one 
which is small in area — say as large as a Lima bean — and of com- 
paratively slight action, the blister healing rapidly after its primary 
effects have passed by. 

Among the inflammatory affections in which counterirritation is 
found very serviceable may be mentioned pleurisy, pneumonia, iritis, 
synovitis (rheumatic or traumatic), cerebritis, and peritonitis (acute 



492 REMEDIAL MEASURES OTHER THAN DRUGS. 

or chronic). A host of more subacute or chronic inflammations are 
also benefited by this measure, some of which are gleet, chronically 
enlarged joints, and inflamed glands. In all these states the blister, 
or more rarely a rubefacient, is to be resorted to; and while it is 
true that nearly all these conditions are accompanied by fever, and 
that fever is generally held to be a contraindication to the use of coun- 
terirritation, blisters undoubtedly do good in such states. In pneu- 
monia or pleurisy, along with the use of veratrum viride in the very 
earliest stages of the disease, a cantharidal blister of the size of a silver 
dollar should be applied near the spot where the pain is most felt or 
on the back near the spine. Where joints are inflamed, the blisters 
should be at some distance from the seat of the swelling, although it is 
often useful to place the counterirritant on the inner or outer aspect 
of the knee-joint if the skin is not reddened. In peritonitis the blisters 
are best applied directly over the seat of tenderness, and in cerebritis 
at the nape of the neck. In gleet a little cantharidal collodion may 
be painted along the under surface of the penis or upon the perineum 
with great advantage in obstinate cases. 

Where an inflammatory process is chronic and resists cantharidal 
blistering, then resort is often had to more severe forms of counter- 
irritation by means of the red-hot — not white-hot — iron, or the use of 
escharotics, such as caustic potash or caustic soda or arsenic. The 
reason for using these is that they all cause so much tissue-change in 
the part that the counterirritation is very prolonged. Sometimes 
antimonial ointment has been applied constantly until a slough forms, 
to accomplish the same purposes. 

For the removal of the products of inflammation resort is had to can- 
tharidal blisters or drugs possessing powers as local irritants and at 
the same time as alteratives. Thus, in pleurisy with effusion it is 
very proper to employ a good-sized cantharidal blister if the effusion 
has a tendency to remain unabsorbed, but if the pleural surface is 
covered with a fibrinous exudate the blister can do little good as far 
as the effusion is concerned till this is absorbed. Some have thought 
that the absorption which follows is due to the abstraction of serum 
which takes place in the bleb formed, but this is a mistaken idea, as 
one often sees an effusion absorbed which far exceeds in quantity the 
amount of liquid in the blister. Under these circumstances the spot 
for applying the blister is, as a rule, immediately under the arm, about 
two or three inches below the axilla. The blister, while it is useful 
in causing absorption in chronic effusions and deposits about joints, 
is not so good as are alterative irritants; for example, iodine, which 
in the form of a thorough application at one sitting until the skin is 
black — not yellow or red — is often of service. In very chronic cases 
iodine ointment, alone or with lard, may be rubbed into the parts 
with advantage, care being taken to stop its use for a day or two as 
soon as the skin reddens. This same treatment is also useful in 
treating enlarged glands in the neck and elsewhere before pus forms. 



CO UNTERIRRITA TION. 



493 



One of the best treatments for epididymitis is to paint the scrotum 
black with many coatings of a strong solution of silver nitrate or iodine, 
to insist on total rest in bed, and to resort to the local use of cold. The 
testicles should also be supported by a suspensory or adhesive strips 
during this treatment, and aconite given if fever is present. 

For the relief of pain resort is very commonly had to the rube- 
facients rather than epispastics, since the more moderate applications 



Fig. 68. 




Showing the areas in which blisters are to be placed : 0, earache or vertigo; M, men- 
ingeal inflammation or effusion at the base of the brain; H, haemoptysis; P L, pleuritis; I, 
intercostal neuralgia; K S, renal or spinal irritation; R, rheumatism or inflammation in joint. 



are equally effective in most instances, and do not leave skin lesions 
behind to remind the patient of his illness. 

Every one who has had stomach-ache and remembers the relief 
obtained by the use of a mustard plaster or spice plaster recognizes 
the value of this means of obtaining relief, and it only remains for 



494 REMEDIAL MEASURES OTHER THAN DRUGS. 

the writer to state that headaches are often amenable to similar treat- 
ment. These headaches may be neuralgic or due to dyspepsia or to 
cerebral anaemia or congestion, but counterirritation will neverthe- 
less do good. If neuralgic, a little menthol or oil of peppermint may 
be applied over the course of the nerve, which application, if it be 
supraorbital, will require care lest the oil gain access to the eye. 

For the treatment of pain in the belly or chest or elsewhere we have 
four means of producing counterirritation in the shape of rubefacients: 
the first is mustard; the second, capsicum; the third, the turpentine 
stupe; and the fourth, the spice poultice. 

The mustard plaster should be made by mixing mustard flour with 
warm vinegar or water, and adding varying proportions of ordinary 
flour to modify its action. If the skin is tender, half mustard and 
half wheat flour may be employed; or if a child is to be treated, 
the proportion should be only one-fourth mustard. The plaster is 
made by placing a piece of stout paper on a table and putting over 
it a piece of heavy muslin or linen. On this is smeared the mustard, 
and over the mustard mass is placed a piece of thin linen, which pre- 
vents the poultice from adhering to the skin and modifies the burning 
according to its density. By folding the edges of the paper so that it 
resembles a picture-frame we have at hand a cheap, effective, and 
strong plaster, the back of which is supported by the paper. 

The spice plaster is made by mixing equal parts of allspice, cloves, 
cinnamon, and nutmegs, and adding thereto one-half part of black 
pepper. These constituents are made into a homogeneous mass by 
using a knife-blade to mix them, and are then sewed in a bag 
which is quilted to prevent sagging of the contents. One side of the 
poultice is now wetted with warm brandy, whiskey, or vinegar, and 
applied to the part desired. If the skin is tender, the proportions of 
pepper and cloves should be decreased. This plaster may be allowed 
to remain over the affected part for hours or even days, and is very 
useful in the treatment of gastric catarrh and indigestion, particularly 
those forms occurring in children. 

The turpentine stupe (see Turpentine) is not to be allowed to 
remain very long on the skin, as it may blister a tender cuticle, and 
the capsicum plaster may be so active as to produce unbearable pain. 

The proper way of treating all such burns from counterirritation 
is to apply simple cerate, cosmoline, or sweet oil, to which may be 
added carbolic acid in the proportion of 1 : 100. The carbolic acid 
acts not only as an antiseptic, but also as a local ansesthetic, while 
the oil serves as a protective from contact with the air. 

Much difference of opinion exists as to the proper treatment of the 
blister formed by cantharides. Where the blisters are small — that is, 
the size of the tip of a finger — they may be allowed to break of them- 
selves, and then be dressed with dry cotton; if they are large, the blebs 
should be punctured at their most dependent part with an antiseptic 
needle and dressed with dry absorbent cotton, as by so doing the new 



DISINFECTION. 495 

skin rapidly forms underneath and is soon able to carry on its normal 
functions. The proper treatment of the blister while it is forming is 
to apply a poultice, which will decrease the pain and aid in the for- 
mation of the bleb. 

CUPPING. 

Cups are used in two forms, the dry cups and the wet cups. The 
first depend almost entirely upon their counterirritant effect for their 
therapeutic value. A hollow glass bulb fitted with a valve or stopcock is 
placed upon the skin and exhausted by means of a small hand pump. 
The stopcock is turned to prevent the entrance of air and the cup 
allowed to remain until sufficient air leaks into it to overcome the 
vacuum and let it fall off. Several such cups placed over the bases 
of the lungs or kidneys relieve congestion and stasis in these organs. 



Fig 




Dry cups applied to the chest, as in a case of pulmonary oedema, the early stages of pneumonia, 

or diffuse bronchitis. 

Dry cups are often employed, and are valuable aids in treating the 
conditions named. Dry cups are not to be used in acute pleurisy or 
peritonitis lest they injure the parietal serous membrane. A wet cup 
is applied as is the dry, but before it is placed on the skin the cuticle 
is incised by a scalpel in several places so that it will bleed freely when 
suction is produced in the cup. It is therefore both counterirritant 
and depletant, and is not to be used in feeble persons who cannot 
stand loss of blood. 

DISINFECTION. 

Before discussing the subject of Disinfection, attention must be 
directed to what is meant by the terms employed when speaking of 
this subject. At present we recognize that the word "germicide" 
is applicable solely to agents capable of killing the lower forms of 
life, whereas "antiseptics" are substances which render material 
with which they come in contact so antagonistic or unsuited to germ- 
development as to render it impossible, at least in an active state. To 



496 REMEDIAL MEASURES OTHER THAN DRUGS. 

use a simile: the killing of the inhabitants of a district by shooting 
them would stop all growth and be germicidal, whereas the destruction 
of the crops in those same parts would only be antiseptic; or, in other 
words, the people might remain, but would starve to death. (See 
article on Antiseptics.) 

We speak of germicides as disinfectants, but never of antiseptics 
as disinfectants if we use these terms correctly, but "germicide" and 
"disinfectant" are synonymous words. 

From what has just been said, it is evident that when dealing with 
filth we should always resort to disinfectants rather than antiseptics, 
for although the latter are good, the former are better. 

We have three ways of destroying germs which are particularly 
useful: The first is the total destruction not only of the germs, but 
also of their resting-place, by means of fire, which may be used in 
the case of old furniture, mattresses, and similar materials, and which 
may be extended to everything which has been about the patient if 
it is necessary to stamp out a brisk epidemic before it can get well 
under way; the second is the use of moist heat in the form of super- 
heated steam, or, better still for common purposes, the use of boiling 
water; and, thirdly, by means of disinfectant materials which have a 
proved reliability. 

Moist heat in the form of superheated steam is infinitely preferable 
to dry heat, but as superheated steam cannot be readily obtained, 
physicians usually direct clothing to be boiled for at least two hours. 

Very often the bed-clothes are taken from a sick-room, trailed 
through the house, and finally deposited at any spot until a conve- 
nient time for boiling them occurs. This is radically wrong and capa- 
ble of causing a widespread distribution of the disease. In all such 
cases the bed-clothes should be rolled off the bed in a bundle and com- 
pletely submerged in a bucket or tub of boiling water, or, better still, 
in a corrosive sublimate solution of the strength of 1 : 1000, before 
they are taken from the room. This tub is now to be carried at once 
to the fire, and the clothes lifted out dripping wet and plunged into a 
clothes-boiler in which the water is actively boiling. The lid of the 
boiler is at once to be put on to increase the heat and prevent the 
escape of any germs in the steam or in the hot air which arises from 
the surface of the water. The active boiling should be continued for 
one or two hours, and water be continually added to prevent scorch- 
ing the contents of the boiler. 

It is important that food be not cooked on the stove at the time the 
clothes are being boiled, and no food should be in the room. 

If boiling cannot be resorted to for any reason, the clothes may be 
soaked in a 1 : 500 solution of corrosive sublimate, or a 1 : 20 solution 
of carbolic acid, although neither of these is so sure a method of dis- 
infection as boiling. 

The care of a room after it has been occupied by a case of 
infectious disease is of great importance, and is generally sadly mis- 



DISINFECTION. 



497 



managed. Disinfection is best accomplished by formaldehyde gener- 
ators, which act by disengaging the gas from pastilles of formalin, by 
the heating of wood alcohol, or by boiling a 40 per cent, solution of 
formaldehyde. The latter is the most efficient method. (See Formic 
Aldehyde.) It does not injure dye-stuffs. 

Novy has invented a very useful generator, and when it is used the 
following rules should be followed : 

1. All openings in the plaster or in the floor, or about the doors 
and windows, should be caulked tight with cotton or with strips of 
cloth. 

Fig. 70. 




Novy's formaldehyde generator. 



2. The linen, quilts, blankets, carpets, etc., should be stretched 
out on a line, in order to expose as much surface to the disinfectant as 
possible. They should not be thrown into a heap. Books should be 
suspended by their covers so that the leaves are separated and freely 
exposed. 

3. The walls and floor of the room and the articles contained in it 
should be thoroughly sprayed with water. If masses of matter or 
sputum are dried on the floor, they should be soaked with water and 
loosened. No vessel of water, however, should be allowed to remain 
in the room, as it will absorb the gas. 

4. One hundred and fifty c.c. (5 ounces) of the commercial 40 per 
cent, solution of formaldehyde for each 1000 cubic feet of space should 

32 



498 REMEDIAL MEASURES OTHER THAN DRUGS. 

be placed in the generating apparatus, and (the delivery-tube being in 
proper position) volatilized as rapidly as possible. The keyhole and 
spaces about the door should then be packed with cotton or cloth. 

5. The room thus treated should remain closed for at least ten 
hours. If there is much leakage of gas into the surrounding rooms, a 
second or a third introduction of formaldehyde at intervals of two or 
three hours should be made. 

A good method of disinfection is to take all movable objects out 
of doors into the fresh air, and then to wash the floor, sills, and casings, 
using a scrubbing-brush, hot water, and soap. The water remaining 
in the bucket should afterward be boiled to kill the germs which may 
be in it. This scrubbing being accomplished, the same surfaces 
should be scrubbed a second time with a solution of corrosive subli- 
mate (1 : 1000 or 1 : 500) and left wet, so that the mercury salt 
may remain on them. Cracks and crannies are to receive particular 
attention. After this is done the floor should be flushed with a solu- 
tion of formaldehyde. 

An essential disinfectant for all diseases is good ventilation. Not only 
should as much air as possible be allowed to enter the sick-room, but 
after the patient has vacated the premises the windows should remain 
open for weeks if possible. Fresh air dilutes germs as fresh water 
dissolves or dilutes dirt. 

The question as to which are the best disinfectant substances is 
one that has attracted the attention of physicians and original inves- 
tigators for years. The result of a vast amount of study and expe- 
rience shows that formaldehyde in solution or in the form of gas is 
the best of all disinfectants (see also Formaldehyde, Part II.), and that 
next to formaldehyde in value is corrosive sublimate in the proportion 
of 1 : 250 to 1 : 500, or even weaker, but that for cheapness, activity, 
and general usefulness chlorinated lime is better still. The disad- 
vantages in the use of corrosive sublimate lie in its ready decompo- 
sition, its formation of an inert albuminate of mercury when 
albumin is present, its inertness where lead pipes are present, and, 
above all, its expense. Chlorinated lime depends almost entirely upon 
its chlorine for any disinfectant power which it may possess. 
Chlorine gas itself is not readily handled, but the lime enables us to 
put it where we will. It cannot be employed to disinfect colored 
fabrics, as it bleaches them. 

Whenever chlorinated lime is bought, the physician should see that 
all the chlorine has not departed from it, as much of the material kept 
in the stores is so old as to be almost worthless. 

For scrubbing floors, chlorinated lime may be made into a solution 
by adding a cupful to a bucket of water, and in privies it may be spread 
thickly over the surface of the mass of filth. 

It is useless to place chlorinated lime in saucers around a room for 
the purpose of disinfecting the air, as the amount of chlorine to the 
volume of air to be disinfected is as nothing. 



ENTEROCLYSIS. 499 

Copperas, or sulphate of iron, while largely used as a disinfectant 
is in reality only an antiseptic. 

Disinfection of the discharges of the patient suffering from an 
infectious disease is an important duty to be remembered. (See 
Urotropin.) The urine and feces should always be received in a 
vessel containing enough corrosive sublimate solution (1 : 500) to kill 
all germs, and to prevent their escape into the air or into water or food 
when the discharges are thrown away. The disinfectant should be 
placed in the bed-pan before, not after, it is used. 

The bed-pan or chamber should not be allowed to stand in the 
room, but be removed and emptied at once in such a manner that its 
contents cannot contaminate any water or food. Its contents should 
not be thrown upon the ground, as the air will dry them and cause the 
germs to be disseminated in the form of dust. 

In very contagious diseases bathing or swabbing off the patient 
with weak antiseptics may be tried. Thus 1 : 10,000 solution of bichlo- 
ride of mercury may be used and the patient afterward wiped off with 
a wet towel. In other instances a 1 : 100 solution of carbolic acid in 
sweet oil may be employed to soften the skin, allay itching, and 
disinfect the patient. This is particularly useful in scarlet fever. 

ENTEROCLYSIS. 

Enteroclysis, or the washing out of the bowel by means of large 
and slowly injected clysters for the purpose of medicating or cleansing 
the large intestine, has within the last few years become one of the 
most valuable therapeutic measures we possess. It is of value not 
only for the purposes named, but also for the relief of intestinal obstruc- 
tion, for the maintenance of bodily heat by the use of hot water, and 
for the reduction of fever by the use of cold water. 

The treatment of choleraic diarrhoea in all its forms by enteroclysis 
was first used by Cantani. The method yielded such good results in 
his hands that he enthusiastically employed it in a large number of 
cases, and caused a number of other physicians to use it. The method 
consists in the slow irrigation of the large bowel by way of the rectum, 
using a solution urged on by the hydrostatic pressure of a fountain- 
syringe. The solution contains as its chief constituent tannic acid, 
which is added in the proportion of from 1 to 5 drachms (4.0-20.0) to 
2 quarts (1920) of water, and 1J ounces (45.0) of wine of opium. 

Carbolic acid is too poisonous, salicylic acid too insoluble, corro- 
sive sublimate too poisonous and too easily decomposed, to be used in 
this manner. 

In some cases Cantani employed a mixture made of 

Infusion of chamomile-flowers 2000 parts. 

Tannic acid 10 " 

Gum arabic 30 " 

Tincture of opium 2 " 



500 REMEDIAL MEASURES OTHER THAN DRUGS. 

Cantani considers that the passage of the ileocecal valve is essential 
for the success of his method, and if this is the case, the reporters 
who have failed to obtain satisfactory results from this treatment have 
probably failed to do more than irrigate the colon. In health it is 
not possible to urge fluid past the ileocecal valve by any degree of 
hydrostatic pressure that is safe. In cholera it would seem that the 
tissues composing the valve are so relaxed that water can enter the 
ileum under an amount of pressure which is within proper bounds. 

This treatment by tannic-acid injections is not founded upon mere 
empiricism, for Cantani and others have found that tannic acid, in the 
strength of 1 per cent., inhibits the growth of intestinal germs in one 
and a half hours at 98° F., while 0.5 per cent, in six hours greatly 
impairs their vitality. Cantani also asserts that tannic acid neutralizes 
the toxins formed by these micro-organisms. This treatment therefore 
contracts the leaking bloodvessels, inhibits the growth of the bacilli, 
prevents the absorption of toxins, acidifies the contents of the intes- 
tine, stimulates the nervous system, warms the body, and prevents 
anuria and collapse. 

The employment of irrigation of the colon in cases of dysentery is 
by no means of recent date. It is only, however, within the last few 
years that this method of treatment has been widely employed or 
studied. Aside from the fact that by this means we can bring medica- 
ments in direct contact with the diseased mucous membrane, there is 
no doubt whatever that the mere passage of normal salt solution at 
suitable temperatures over the bowel- wall is of value, for in this man- 
ner we remove mucus and pus, and so dilute the poisons manufactured 
by the germs of the disease that their further action is largely inhibited. 
In adults the use of irrigation in dysentery should be carefully carried 
out by means of an inflow and an outflow tube, the first being attached 
to a fountain-syringe. The outflow tube must be large enough to 
permit of the liquid leaving the bowel with a readiness equal to that 
of its inflow, and must be so straight and patulous as to permit of the 
fluid carrying away with it from the bowel any flakes of mucus or other 
foreign matter. The inflow tube should be introduced a consid- 
erable distance into the bowel and the outflow tube placed just within 
the sphincter. The method employed in giving the injection, the tem- 
perature of the water, and the gentleness of the operation are exceed- 
ingly important, and will be discussed below. The amount of water 
employed in irrigation of the bowel in dysentery is not to be measured 
by quarts, but by results. It should continue to flow in until it comes 
from the outflow tube perfectly clear, showing that our object — 
namely, thorough cleansing of the bowel — has been accomplished. 
The best medicament to be added to the water is boric acid or tannic 
acid, each of which is harmless and capable of doing much good. 
In nearly all instances in which we wish to cleanse the bowel a nor- 
mal salt solution should be employed rather than pure water, as the 
latter tends to irritate the intestinal wall. 



ENTER CL YSIS. 501 

The question as to what is the best method of treating a ease of 
intestinal obstruction by other than operative means is one which is 
of interest to the physician as well as the surgeon. Such cases gen- 
erally come into the hands of the general practitioner first, and it is 
for him to decide, as a rule, whether the surgeon shall be called in 
consultation. Measures directed to the relief of the patient without 
the use of the knife are first to be tried. No one who has studied 
this subject can doubt that enteroclysis is a valuable measure in cer- 
tain cases. Used properly, there is little danger of its doing harm, 
and some chance of its accomplishing good. The author is not one 
of those who place much confidence in the reports of cases of volvulus 
overcome by this means. The true indication for rectal injections 
is intussusception or obstruction due to impacted feces. Even in 
such cases the injection treatment should not be persisted in for a 
period exceeding twelve hours. If the second injection fails to give 
relief, operation must be resorted to. 

A very important point to be decided in connection with this sub- 
ject is the amount of pressure that can be used with the stream of water 
which is employed, the length of time during which the injection may 
be given, and, finally, the temperature and character of the fluid 
injected. As is well known, the great majority of cases of intussus- 
ception take place at the ileocecal valve, and, if not here, in the sig- 
moid flexure. Pressure by injection is therefore readily brought to 
bear on the area involved. It has been claimed that certain pressures 
will cause rupture of the peritoneal coat of the intestine, but Dr. Martin 
and the writer failed to produce this lesion in the dog by any pressure 
we could employ, since before this occurred the liquid passed through 
the stomach and mouth. To employ a pressure exceeding eight 
pounds is, however, distinctly dangerous, not because the intestinal 
wall in health will not stand this as a rule, but because it is near the 
injury line, and if any disease or softening of the bowel exist, it is 
almost certain to cause rupture. A pressure of from two to five 
pounds is, as a rule, as much as may be employed, and this pressure 
should be reached by degrees, starting the injection at such a pressure 
that the flow amounts to hardly more than a trickle, and increasing 
the pressure as the antagonism of the bowel is overcome. Finally, 
when the bowel is fully distended up to the point of obstruction, the 
pressure on the no longer moving column of water may be increased, 
if necessary, to six or eight pounds by raising the bag of water not 
more than three feet. In infants, in whom invagination so often 
occurs, a pressure greater than two pounds is dangerous, and it is of 
vital importance that the pressure be employed properly, otherwise 
it will do more harm than good in several ways. As a rule, in our 
anxiety to give the patient relief at once we are inclined to use too 
much force and too large a bulk of water, and think that active force, 
if such a term may be used, is to be resorted to. Those who have 
seen these cases have learned by experience the harmfulness of such 



502 REMEDIAL MEASURES OTHER THAN DRUGS. 

measures, and have also learned how great is the expulsive power of 
the bowel when it is excited to contraction. If this power be brought 
into activity, it will be almost impossible to inject fluid into the rectum, 
and, worse than all, the muscular fibres of the intussuscipiens take a 
still tighter grasp on the intussusceptum. 

The dangerous practice of using a Davidson or any other kind of 
hand force syringe in the treatment of this class of cases is to be 
condemned. Three unreported cases of rupture of the bowel and death 
from the employment of the Davidson syringe for this purpose have 
occurred, because the amount of force used was indeterminable, and 
because the fluid was injected with a jerking instead of a constant flow. 
The amount of fluid injected should be large, and if it is impossible to 
get a large amount into the bowel, it is probably because the inflow has 
been so rapid as to excite intestinal opposition. If, by a slow trickle 
of water into the bowel, gradually increasing the pressure, we are 
unable to give relief in forty-five minutes, it is necessary either to 
abandon this treatment as useless, or else allow the liquid to flow away 
and resort to the measure again after some hours. Practical experience 
has shown that the second or third injection sometimes succeeds, prob- 
ably because it is more skilfully given and the first has prepared the 
way for the others; but it is to be remembered that the chances for 
reduction of the obstruction are best with the first injection if it is 
properly given. Frequently repeated small injections are absolutely 
unjustifiable, as they tend only to cause spasm of the bowel. 

Finally, the author cannot leave this subject without saying a word 
concerning the temperature of the injected liquid and its constitution. 
An injection of this kind goes into the very heat-citadel of the body, 
and if too cold, as it often is, produces dangerous chilling of organs 
which are ordinarily especially protected from cold by the omental 
apron and intestines. By repeated experiments, Martin and the author 
found that w^ater at 65° F. lowered the bodily heat three degrees in 
thirty minutes. The use of colder water than this (52° F.) resulted 
in death in twelve hours, and the post-mortem showed intense conges- 
tion of the colon, which contained bloody mucus. 

The use of water of too high a temperature is also dangerous, lest 
it produce heat-stroke. Of course no one would use water hot enough 
to produce local harm, yet it is necessary to have just enough heat 
and no more. Martin and the author proved that the use of water 
at 115° F. caused in twenty-five minutes a rise of bodily temperature 
in the axilla of nearly five degrees, and developed marked symptoms 
of heat-dyspnoea. The temperature which it is right to employ we 
found to be 101° to 103° F. as the water entered the bowel, or even 
as high as 104° F. in the water-bag if a long tube were used, as under 
these circumstances the water is rapidly cooled. An interesting result 
of these experiments as to heat is that when cold water was used it 
took four times as long to make the injection as when moderately 
warm water was employed. 



GAVAGR 



503 



If very large injections are used, a normal saline solution of 7 : 1000 
(1 drachm to 1 pint) should be employed to avoid the abstraction of 
vital salts from the intestinal wall, with consequent passage of water 
into the tissues, making them boggy, due to the law of osmosis. If 
the saline solution is stronger than this, it abstracts water from the 
bowel wall and causes thirst. Rectal injections are very useful to 
relieve thirst and keep the kidneys active after abdominal operations. 

Distention of the bowel by injection produces little if any effect on 
the circulation and respiration, but the passage of large amounts of 
warmed fluid directly into the closed abdominal cavity causes death 
rapidly. 



Fig. 71. 




Showing the introduction of a soft catheter through the right side of the nose in the 
practice of gavage. 



GAVAGE. 

Gavage is a term applied to the forced feeding of patients who will 
not or can not swallow food. The method is often employed in 
nourishing the insane who refuse food. A soft-rubber catheter is 



504 REMEDIAL MEASURES OTHER THAN DRUGS. 

passed through one of the nasal chambers back into the pharynx, a 
small funnel is attached to its outer extremity, and the milk, or beef- 
broth, or other liquid food is by this means introduced into the pharynx, 
where the muscles of deglutition seize it. The term gavage is also 
correctly employed to the forced feeding of a patient by an oesophageal 
tube, as in the use of lavage. (See Lavage.) 



HEAT. 

Heat is used locally for a number of purposes in the same manner 
as is cold, and, as was stated in the article on Cold, the choice of heat 
or cold in the treatment of any acute form of inflammation depends 
almost entirely upon the wish of the patient, who generally can tell 
at once which will give him the greater comfort. 

In sprains of the ankle nothing compares to a hot foot-bath pro- 
longed for hours, the object being to decrease the pain and swelling, 
thereby regaining the use of the limb. The high degree of heat which 
can be borne by gradually increasing the temperature of the water 
by the addition of small quantities of scalding water is very extraordin- 
ary, and the favorable results obtained are in direct ratio to the height 
of the temperature. Between these soakings the part should be dressed 
with lead-water and laudanum, and rubbed with ichthyol ointment 
or camphor liniment and laudanum. 

In spasmodic affections involving either striped or unstriped mus- 
cular fibre the local application of heat is a very useful means of relief. 
Sometimes in lumbago, or muscular stiffness in other parts of the 
body, the use of an ordinary hot laundry iron over the affected parts 
will prove of great service, the skin being covered by several layers of 
newspaper to afford a smooth surface over which to pass the iron and 
to protect the parts from too great heat. 

In chordee the best means for rapid relief, other than the use of 
drugs or general relaxants, such as amyl nitrite, is to steep the penis 
in hot water. A hot sitz-bath before going to bed is a good prophy- 
lactic against this painful complication of gonorrhoea. 

In croup of the spasmodic type the local application of a hot com- 
press, made by wetting spongiopiline with hot water, is very useful, 
or, if spongiopiline cannot be had, several layers of flannel should be 
wetted, placed on the neck, and covered with cotton and oiled silk so as 
to prevent the roll becoming chilled. 

Nearly all forms of pain in the eyes can be much relieved by the 
application of heat. Thus iritis, corneal irritation and ulceration, and 
pain due to eye-strain can be greatly relieved by the use of hot water 
applied by cotton pledgets frequently renewed, but never allowed to 
remain on long enough to act as warm poultices. Another method is to 
allow water as hot as can be borne to drop upon the lids from a fountain- 
syringe. The water-bag should not be more than two feet above 



HEAT. 505 

the patient's head, and the fluid should drop on the eyelid from the dis- 
tance of a few inches only. 

Where attacks of dysmenorrhea depend upon spasmodic closure 
of the cervix, with simultaneous spasm of the fundus uteri, a hot sitz- 
bath or hot vaginal injection is useful, and this treatment is also of 
value where uterine congestion results in leucorrhcea or a sensation of 
weight in the pelvis. 

Sometimes attacks of torticollis may be subdued by applying hot 
compresses to the sternomastoid muscle. 

The local application of heat may serve to determine whether the 
inflammatory process has gone on to the formation of pus. Before 
pus is formed heat decreases the pain, it is claimed by Lewin, but 
afterward greatly increases it. 

Heat is largely used at present for medicinal purposes, when the skin 
or kidneys are torpid, to aid in the elimination of impure and effete 
materials from the blood and tissues. It is employed in two forms, 
the dry and the moist, commonly called the Turkish and Russian baths 
respectively, and may be taken under home arrangements or in one 
of the establishments found in all large cities. 

The Turkish bath consists of a series of rooms ranging in tempera- 
ture from 100° to 1 50° F. or more, into which the individual passes 
successively until the hottest room is reached. In each chamber 
he lingers until the system becomes accustomed to the high tempera- 
ture, and perspiration is well established before he enters the hottest 
room, where he remains for a varying length of time according to 
the advice of his physician or his own whim or comfort. The rule 
governing his stay is that he must leave it at once if any sense of oppres- 
sion is experienced or if perspiration does not flow freely. Some- 
times a glass of cold water taken at this time causes a sudden profuse 
sweat, and also relieves any overheating by abstracting many units 
of heat. The cold water in the centre of the body causes contraction 
of the bloodvessels in these parts, and the blood, rushing to the surface, 
causes the sweat glands to pour out their secretion. 

Following the stay in the warm room, the individual passes into 
still another chamber, where he is shampooed from head to foot, well 
rubbed, and the blood made to circulate through the skin. The 
shower-bath is then used, at first hot or warm, and finally changed to 
a dash of cold, or, better still, the patient plunges into a long tank, 
swims to the other end, and is there met by an attendant who rapidly 
dries his skin, wraps a cover round him, and shows him to a 
lounge, where he is supposed to sleep for an hour or so. The air 
of this sleeping-room is at the ordinary temperature of a living- 
room. 

Reviewing for a moment the effects of this bath, we find that the 
first two-thirds are devoted to the opening and stimulation of the 
pores of the skin, while the last third is devoted to the contraction 
of these pores and their supplying bloodvessels. In other words, it 



506 REMEDIAL MEASURES OTHER THAN DRUGS. 

is necessary to use the cold to prevent gradual chilling of limited areas, 
which would result in internal congestion. If the patient receives a 
cold douche, the natural rebound prevents congestion of a permanent 
nature, whereas if he is exposed to cold a long time, these stagnated 
areas become permanently diseased. The physician must always 
remember that this cold douche or plunge is a sine qua non, and that 
a rest after the bath before dressing is almost equally important. If 
the patient is too weak to bear the cold, he must not use the bath. 

The indication for the Turkish bath as a medicinal measure is any 
condition of the emunctories of the body whereby effete matters are 
not properly eliminated, as in Bright's disease in its various forms. 
The increased action of the skin not only casts off impurities for the 
time being, but frequent repetition of the bath causes functional 
hypertrophy of the sweat glands, and eventually enables them to do 
more work, or, in other words, to cast off an increased quantity of 
effete material. As a consequence of this the patient is able to decrease 
the tendency to uraemia or other evidences of Bright's disease, and, 
employing the normal epithelium still left in the kidney for constant 
use, uses the bath once, twice, or thrice a week with the object of 
abstracting the excess of impurities which the impaired kidneys cannot 
remove. The frequency of the bath depends, therefore, upon the 
rapidity with which the effete materials accumulate. In a case of 
Bright's disease the patient should not attempt to use the room con- 
taining high heat at first, and should be accompanied by a medical 
attendant to watch for untoward effects, particularly if the heart is 
diseased or uraemia is already shown by headache or other signs. If 
sweating does not come on at once, danger is at hand from acute 
uraemia, renal and cerebral congestion, or heat-stroke. 

Not only is the Turkish bath useful for kidney disease, but it is 
often of great service in rheumatism. The acute form of rheumatism 
is rarely so treated, because cardiac complications forbid exposure 
to heat, and fever is generally present. In subacute and chronic rheu- 
matism the case is different, and the enlarged joints or inflamed muscles 
greatly improve in some instances from such treatment. Further than 
this, the muscular stiffness following prolonged or severe effort can 
be so avoided, and neuralgia depending upon rheumatic or gouty taint 
may be relieved by the hot-air bath. 

Acute colds affecting the nasal cavities or other parts of the body, at 
an early formative stage, can often be aborted by a thorough Turkish 
bath, and when further developed are often greatly relieved by the same 
means. If, however, congestion of the lung, pneumonia, or chronic 
bronchitis, with emphysema or a dilated weak heart, is present, the 
bath may be dangerous. In acute pharyngitis, in which the pharynx 
feels like a raw surface or "as if it were filed or scraped/' the bath 
will give relief in many instances. 

Sometimes in suppression of menstruation from cold the flow may 
be restored by a Turkish bath. 



HEAT. 



507 



Same persons complain that they are always catching cold upon 
the slightest exposure and apparently without cause. One class 
seem to have delicate mucous membranes readily susceptible to irri- 
tation and inflammation; the other have dilated or relaxed peripheral 
capillaries, which readily allow the blood in them to become chilled, 
and the individual consequently suffers from internal local congestions. 
Two separate means of treating such cases exist. The first class will 
do well on minute doses of arsenous acid (grain y^-g- to -^) three times 
a day, used for weeks; the second will be cured of their habit by the 
use of a Turkish bath twice or thrice a week, since by this means the 
peripheral capillaries are toned up and made more active. 

Fig. 72. 




A method of giving a bedridden patient a hot-air bath where a sweat is desirable, or where 
shock with a collapse temperature is to be controlled. The bed-clothing is raised by a cradle. 
An alcohol lamp is placed under the inverted funnel, and the hot moist air is carried in this 
way to the patient without any danger of fire or of burning the skin by hot bottles. 



The Turkish bath, as thoroughly carried out in large cities, is not 
obtainable for those living elsewhere, so it is well to describe a home 
modification which, with attention to detail and care, may prove almost, 
if not quite, as effective a remedy. (See Fig. 50, p. 320.) 

The patient is placed upon a wooden chair, naked, and under the 
chair a small alcohol lamp is put, which is lighted. The individual is 
now wrapped thoroughly, chair and all, with one or two large blankets, 
when the heat of the lamp soon causes profuse sweating. Many cases 
are, however, on record where the lamp has been upset and the patient 
badly burned. The best way is to have the lamp a little to one side 
and its flame immediately under the mouth of an inverted funnel 
attached to a piece of tin tubing, the free end of which is placed under 
the blanket, so that the hot air and vapor may surround the body. 
If the tube be covered with cloth, the loss of heat is slight and the 



508 



REMEDIAL MEASURES OTHER THAN DRUGS. 



danger of burning the patient is removed. If this is not practicable, 
several very hot bricks or stones, thoroughly heated in an oven, may 
be placed under the chair, or small heated logs of wood may be 
substituted. 

When the patient is too feeble to sit in a chair, then it is wise to 
place an alcohol lamp at the foot of the bed, with an inverted funnel 
attached to a tube which passes under the bed-clothing in such a way 
as not to bring the hot air directly against the skin of the patient. The 
bed-clothing may be slightly raised to allow the hot air to enter. The 

Fig. 73. 




Nurses using two broom-sticks to wring out a blanket dipped in very hot water for use in the 
hot pack. (From the author's wards.) 



vapor of the alcohol lamp tends to sweat the patient. This is also a 
valuable mode of using external heat in cases of shock. (Fig. 72.) 

The Russian bath differs from the Turkish in that the heat used is 
moist, not dry. As a consequence the danger of heat-stroke and similar 
states is much increased, because evaporation from the skin does not 
go on so rapidly and the body is not cooled so well. 

The hot moist bath can also be obtained by seating the patient on 
a wicker chair under which is placed a bucket of hot water. The 
patient is surrounded by a blanket, and a large hot iron or stone is 



HEAT. 509 

put into the water, causing the development of a great amount of 
steam. 

This method of treatment is useful in the same states as is the 
Turkish bath, but is more rarely used. It may also be employed to 
develop the rash of any of the exanthematous fevers when it is sup- 
pressed by cold or is not "well out" on the skin. 

Under the name of the "hot pack" still another substitute for the 
Turkish or Russian bath is used, not only to cause sweating and so 
relieve the patient of poisons and fluid in renal diseases, but also to 
relax muscle spasm and to relieve nervous excitement and nervous 
insomnia. It is particularly efficacious in the insomnia of severe 
chorea in children, and mav be used in tetanus. 



Fig. 74. 







Showing arrangement of blankets in giving a hot pack for uraemia. (From the author's wards.) 

A bed is prepared by covering it with a rubber blanket. Over this 
is placed a dry woollen blanket. A large, heavy blanket is now dipped 
in very hot water and then wrung out (see Fig. 73), and the naked 
patient quickly wrapped in it, the dry blanket being folded over him 
after several hot-water bottles have been placed alongside the patient. 
Finally the sides of the rubber sheet are drawn around and over the 
patient and an ice-cap placed on the head. (Fig. 74.) A thermometer 
should be placed in the mouth every fifteen minutes, and if the patient's 
temperature becomes febrile (101° F.) he should be taken out of the 
blankets and rubbed dry. Ordinarily the bath should last about one 
hour, and if sweating does not speedily come on a glass of cold water 
should be taken to drive the blood to the skin. In adults a little gin 
may be added to it, or sweet spirit of nitre may be used in this way in 
children and adults. If no sweat develops and the temperature begins 
to rise, the patient must be taken out of the bath at once. 

Another wet pack, which speedily becomes a warm one, is used in 
cases in which, during the course of an eruptive fever, the eruption fades 
and it is desired to bring it out on the surface. It is also useful in those 
cases of severe chorea in which the child can withstand the first shock 
of the cold. It consists in wrapping the child in a cool wet sheet 
and over this wrapping one or two blankets. In a few minutes the 



510 



REMEDIAL MEASURES OTHER THAN DRUGS. 



sheet becomes heated by the body and the sweating which results is 
profuse. 

Whenever the Turkish or Russian bath or hot pack is used, except 
in the exanthematous fevers, it should be followed by a cold sponge, 
plunge, or douche. 

Although these baths have been used in the treatment of cases of 
heart disease to relieve dropsy and renal engorgement, they are not 
safe, and should not be generally employed. All acute or chronic 
diseases of the lung, except acute bronchitis of a mild form, contra- 
indicate their use. 

A valuable method for using moist heat in a mild form is the "bron- 
chitis tent." (See article on Bronchitis.) 

Ftg. 75. 




Frazier-Lentz hot-air apparatus. 



The use of a high degree of dry heat for the cure of inflammatory 
states of the sheaths of the joints and muscles has recently been made 
once more popular by the introduction of a double copper cylinder 
closed at one end, inside of which is placed the limb which is affected. 
The limb is prevented from coming in content with the cylinder by 
means of a board padded with asbestos and by putting pads of linen 
under the parts which touch the asbestos. A thermometer is placed 
so that its bulb extends into the cylinder, and a few holes permit of 
the moderate circulation of air. Bunsen burners or alcohol lamps are 
now lighted and placed under the cylinder, and the orifice through 
which the limb enters it is closed by drawing around the limb an 



HYPODERMOCL YSIS. 



511 



asbestos curtain. The temperature is allowed to rise to 200° to 300° F., 
and the treatment resorted to daily, or several times a week, the indi- 
vidual seance lasting about one hour. The free sweating of the limb 
and the circulation of the blood and lymph prevent it from being burnt, 
but care must be taken that it does not touch the metal. Usually the 
entire surface of the body sweats profusely during the sitting. 



Fig. 76. 




Kelley's hot-air apparatus. 

The author believes this method to be of great value in cases of 
chronic inflammatory joint-affections due to rheumatism or following 
injuries, but of little service in those due to gouty swelling. In sub- 
acute gout he has seen it precipitate an attack of universal acute gout, 
apparently by setting free large amounts of uric acid from the affected 
joints. 

This method of treatment is always to be considered as a valuable 
aid in the treatment of the more obstinate cases of the character 
described. The best form of this apparatus is expensive. A less 
expensive apparatus is shown in Fig. 76. 



HYPODERMOCLYSIS. 

Hypodermoclysis is a method of supplying fluid to the body to replace 
that lost through excessive purging, as in cholera, or in cases of hemor- 
rhage. Further, it may be used to wash from the body various impuri- 
ties circulating in the blood and lymph, and to flush the kidneys. In 
other instances it may be used to supply the body with liquid when 
the stomach will not permit liquid to be swallowed, as in vomiting, or 
gastric ulcer or after abdominal operations. It consists in the intro- 



512 



REMEDIAL MEASURES OTHER THAN DRUGS. 



duction into the subcutaneous tissues of normal saline solution, which 
is rapidly absorbed by the vessels. As is well known, a quantity of 
liquid equal to four times that of the normal amount of blood may 
be passed directly into the veins without producing a rise of blood- 
pressure, and experiment has shown that usually within fifteen minutes 
after the fluid flows into the subcutaneous tissues an increased flow 
from the kidneys takes place. It is not safe to infuse a greater quantity 
of liquid than 1 drachm to each pound of body-weight in each fifteen 
minutes, as, if this amount is exceeded, the accumulation of the liquid 
in the system is so great that the tissues become bathed and finally 
drowned, because the kidneys cannot excrete the liquid fast enough. 
To carry out the operation, the sterilized liquid to be infused — the 
formula on page 537 is the best — is placed in a glass irrigator jar oi 



Fig. 




The apparatus and method used in giving hypodermoclysis. The ordinary irrigator is attached 
to a small canula, and this is placed in the loose tissues of the belly-wall. 



rubber bag, which is absolutely aseptic. From the lower part of the 
vessel leads a rubber tube to which is attached a canula, also 
rendered sterile. The skin over the place where the liquid is to 
enter is to be rendered absolutely sterile, the trocar is then inserted 
into the subcutaneous tissue of the thigh, or, preferably, of the 
abdomen, or below the breast, and the liquid allowed to flow at a rate 
named, the pressure being obtained by raising the container two or 
three feet above the belly-wall. (Fig. 77.) As the liquid enters, a 
swelling appears in the subcutaneous tissues, which soon disappears 



INHALATIONS. 513 

after the infusion ceases, and is much aided in its absorption by the 
use of very gentle rubbing or stroking. 

When hypodermoclysis is employed after hemorrhage, the results 
are often extraordinary. It is of great value in the collapse of 
cholera. The cyanosis decreases rapidly, the pulse improves, and 
respiration is no longer difficult. Some physicians have used hypo- 
dermoclysis with very good results in the treatment of uraemia, and 
the author believes that not only are the poisons washed out of 
the system by this method, but, in addition, that the dilution of the 
poisons prevent them from acting so severely. In septicaemia, diabetic 
coma, and similar states this method of treatment should be employed 
and the results carefully recorded. When general dropsy is present, 
it is manifestly useless. Hypodermoclysis has also been used with 
great advantage in the treatment of severe burns to overcome shock 
and toxaemia. 

In cases of surgical shock warm saline fluid used by hypoder- 
moclysis is often of great service. (See also Intravenous Injection; 
Transfusion.) 

INHALATIONS. 

The value of inhalations is not recognized sufficiently by the medical 
profession. As a matter of fact, they are capable of aiding us very 
much in the treatment of disease and of producing results otherwise 
unobtainable. The employment of inhalations may be divided into 
the properly modified use of atmospheric air and the employment of 
atmospheric air charged with medicinal substances. To carry on many 
of the forms of treatment which have been found of value requires 
cumbersome or costly apparatus which cannot be used except in insti- 
tutions; but nevertheless the general practitioner can employ remedial 
measures by way of the respiratory organs with great advantage to 
himself and his patients even when far removed from places where 
costly apparatus can be had. 

The first form of inhalation to be studied is that which is devoted 
to proper respiratory exercises. These exercises are required by patients 
who because of faulty development do not properly expand certain 
portions of the chest in the function of respiration and by those who 
have acquired impaired respiratory movements through the following 
of certain occupations or as the result of attacks of disease. 

There can be no doubt that pulmonary tuberculosis may be pre- 
vented, or even arrested in its earliest stages, by causing a patient to 
use proper thoracic exercises, which must usually be directed toward 
producing expansion of the apices of the lungs, a part of these organs 
which in many instances is but poorly filled and equally ineffectively 
emptied under ordinary conditions of life. The following inhalation 
exercises are to be directed for such cases: 

The patient stands with his back against a wall, holding himself 
as erect as possible and bringing his shoulder-blades flat against the 

33 



514 



REMEDIAL MEASURES OTHER THAN DRUGS. 



plane behind him. He now takes a slow, deep, and full inspiration, 
drawing the air into the chest in a steady stream, and not by a sudden 
jerk of the respiratory muscles. The inspired air is to be held in 



Fig. 7* 




Standing erect. 
Fig. 80. 




Wing standing, side bending. 



Fig. 79. 




Stretch standing. 
Fig. 81. 







Wing standing, trunk rotation. 



the chest while the patient mentally counts three, and then allowed 
to escape gradually, and not forced out of the chest by sudden mus- 
cular effort. Usually four or five such movements night and morning 



INHALATIONS. 



515 



are quite sufficient for good results for the first week. After that time 
they may be gradually increased in number. 



Fig. 82. 



Fig. 83. 



Y"\ 



>?:\ 



r*t«fk'i 





Wing standing, knee bending 
or curtseying. 



Stride standing, forward bending, or hewing. 



Fig. 84. 



Fig. 85. 





Half wing, half stretch, standing; 
forward bending, or sawing. 



Wing standing, leg circling. 



Another movement may now be added to that just described. The 
patient, standing with the back against the wall and the shoulders 
well thrown back, .raises his arms, which are completely extended, 



516 REMEDIAL MEASURES OTHER THAN DRUGS. 

from the sides until the hands are on a level with the shoulders, thereby 
fully expanding the sides of the chest. As expiration begins the arms 
are allowed to fall gradually to the sides. After this the arms may be 
carried above the head into a perpendicular position. 

A third exercise consists in inhaling as deeply as possible and then 
exhaling against resistance produced by closing the lips and forcing 
the air between them. 

The fourth exercise consists in lying upon a firm bed with a small 
pillow under the hollow of the back and no pillow under the head, and 
then taking slow, long-drawn inspirations and expirations as already 
described. 

These exercises are useful not only in persons with faulty chest 
development, but also in those who have poor expansion of a lung 
after a pneumonia, pleurisy, or empyema. 

The increase in the volume of air respired under gentle but per- 
sistently taken exercise of this character is quite remarkable and these 
movements often increase the appetite, the proportion of haemoglobin, 
and the general health of the patient. 

In addition to these exercises there are others which, while not 
directly connected with breathing, produce nevertheless deeper respira- 
tions and at the same time develop the chest muscles and cause the 
patient to hold himself erect, thereby preventing or correcting faulty 
pulmonary expansion. Nearly every physician can look back upon 
cases in which a slovenly carriage of the shoulders in early life has 
resulted in impaired chest expansion and finally in actual disease. 
The exercises to be ordered are shown in Figs. 78 to 85. 

The next class of exercises consist in using simple forms of apparatus 
in association with respiratory movements. These are advantageous 
not only because they are beneficial in themselves, but also because 
they interest the patient and cause him to take exercises of which he 
might tire if they were performed without appliances. 

The first of these consists in a pair of Wolff bottles joined together 
by a piece of rubber tubing. (Fig. 86.) The bottle nearest the patient 
is filled with water, and the patient after taking a deep inspiration at 
the moment of expiration places a mouth-piece attached to a rubber 
tube between his lips and forces the water over from the first to the 
second bottle. This is usually sufficient for an exercise, and later in 
the day the patient drives the fluid from one bottle to the other a 
second time. Such a procedure causes the patient to take full inspira- 
tions and forcible, though gradual, expirations, with the result that he 
fully expands portions of the lungs hitherto but imperfectly inflated. 
It is therefore of value in patients with poorly developed chests, in 
cases after an attack of pneumonia, when complete resolution is long 
delayed, and in instances of deficient pulmonary expansion because of 
adhesions following an attack of pleurisy. In cases of empyema after 
drainage is established it is useful in that it aids drainage, keeps the 
pleural cavity free from pus, and gradually causes the lung to descend 



INHALATIONS. 



517 



once more into the lower part of the thorax. This practice is a very 
useful one in children, who may otherwise suffer from deformity due to 
collapse of one side of the chest if the lung is not properly expanded. 
It is not to be practised immediately after the removal of a pleural 
effusion or empyema, because time must be given the lung to expand 
naturally and adjust itself to the relief of pressure. 

Fig. 86. 




Arrangement of bottles for promoting lung expansion. 

Another form of apparatus, designed for the same purpose as that 
just named, is "Denison's Resistance Inhaler." (See Fig. 87.) The 
physician having determined that the patient is to inhale air against 



Fig. 87. 




Denison's resistance inhaler. When in use the cap at the end of the inhaler is removed and 
air is drawn into the square chamber, which contains a piece of folded absorbent paper or cotton 
wet with some of the volatile oils named in the text. The air then passes to the patient by 
way of the mouth-piece, meeting, however, a resistance valve on the way designed to produce 
forced inhalations. On expiration the air goes through the mouth-piece as far as the perforated 
elevated column, where, by a valve, it escapes. By means of the cap on top of this column the 
resistance offered by the valve to the escape of the air is increased or diminished as is desired, 
so that the patient expires against resistance. 

resistance, the valve is fixed to yield to a pressure caused by his forcible 
inspiration. On the other hand, when the patient exhales the muscles 
of the chest must use sufficient pressure to force the air past the expira- 
tion valve. The result is that every part of the lung is expanded, the 
respiratory muscles are exercised and strengthened, and what might 
be called slovenly or imperfect breathing is corrected. 



518 



REMEDIAL MEASURES OTHER THAN DRUGS. 



We now pass to the consideration of inhalations designed to carry 
medicinal substances into the lungs for their effect on the respiratory 
tract or to influence the general system, not including, however, the 
use of general anaesthetics. The air respired may be medicated by 
the following methods: (1) Setting free in the air of the room 
volatile substances derived from chemical or vegetable sources, using 
materials which are naturally volatile or which can be made so 
by the aid of dry or moist heat. (2) The use of a mask or inhaler so 
arranged that a part at least of the inspired air must pass through 
or over a sponge or piece of cotton moistened with the medicament. 
(3) The nebulizing of substances which are not volatile, by the use of 
compressed air. 

The use of chloride of ammonium fumes in cases of chronic bron- 
chitis is described in the article on Ammonium Chloride. In cases 



Fig. 




Chamber inhaler (Hassall). The shelves are made of cotton cloth, upon which is poured 
the medicine to be employed. 



of spasmodic croup a few crystals of menthol placed in an iron spoon 
may be volatilized over a gas jet or lamp chimney, and so diffuse the 
vapor through the air. (See Croup.) 

Creosote is said to produce very good effects in whooping-cough, 
and in bronchitis in its later stages, if cloths wet with it are hung about 
the room. So, too, turpentine, terebene, eucalyptol, and similar 
substances can be used in place of creosote, and in doing so the 
apparatus for diffusing these drugs in the air described by Hassall 
may be employed. (Fig. 88.) 

In other instances it is better to set free these and other substances 
by the aid of steam, allowing the steam to escape freely into the air of 
the room or to enter a "bronchitis tent." (See article on Bronchitis.) 
5 to 20 minims (0.3-1.3) of any of the substances just named may be 



INHALATIONS. 



519 



added to the water when it is boiling. Menthol may also be so used, 
placing 2 to 5 grains (0.12-0.3) in the hot water at a time. The steam 
allays irritation by increasing the moisture in the air of the room, checks 
coughing, and aids the action of the drugs. In the article on diphtheria 
an additional formula for such cases is also given for use in this manner. 
The drug to be used may be placed in the water in an ordinary teapot 
heated by a lamp, or gas jet, or the "croup kettle" may be employed 
(Fig. 89), or in its place the appliance shown in the article on Bronchitis. 
In other instances the apparatus shown in Fig. 90 may be used. In 





Fig. 89. 


















mm 


^jfejtf^ 








BH 


: 








i 


MB 






9 















Croup kettle and inhaler. 



this arrangement the medicated steam is generated in the boiler and 
then escapes from the upper end of the tube and is inhaled by the 
patient, who brings his face as near to the apparatus as the heat will 
permit. 

The following formula is useful in many cases of pulmonary tuber- 
culosis and bronchitis with a dry cough, if placed in such a steam 
inhaler: 

Ifc— 01. pini svlvestris f Bj (30.0). 

01. eucalypti f 5j (30.0). 

Creosoti f gss (16.0).— M. 

S. — Place 1 to 3 drachms (4.0-12.0) in the water in the boiler and inhale the steam 
three or four times a dav. 



520 



REMEDIAL MEASURES OTHER THAN DRUGS, 



If there is excessive cough, J ounce (15.0) of spirit of chloro- 
form may be added to the above prescription with advantage. 

In many cases of acute laryngitis the following formula is of excellent 
service if used in this manner: 

Py — Tine, benzoin, comp foj (30.0). 

Menthol- gr. x (0.60). 

Spt. chloroform f oss (16.0).— M. 

S. Place 1 to 2 drachms (4.0-8.0) in the water in the boiler, inhaling the steam 

from a freshly made watery mixture several times a day. 

After using steam inhalations the patient must not inhale for several 
hours the outdoor air if it is cool. 

Fig. 90. 




Steam vaporizer. 



For use with the mask or face inhaler (Fig. 91) or Denison's inhaler 
(Fig. 87), the following formula is valuable in cases of chronic bronchitis 
with excessive cough: 

P,— Chloroform f§ss (16 0) 



S.- 



Creosoti foss (16.0). 

Menthol gr.x (0.60).— M. 

■10 drops on the inhaler every three hours. 



INHALATIONS. 



521 



Any one of these ingredients may he used alone. Sometimes where 
it is desired to liquefy tenacious bronchial mucus 10 drops of iodide of 
ethyl may also be placed on the inhaler to act as a stimulant expec- 
torant. The mask or Yeo inhaler must be used almost constantly if 
it is to produce good results. 



Fig. 91. 




Yeo's inhaler, made of perforated zinc bound on the edges with chamois skin and supplied with 
elastic loops to go back of the ears or around the head On a sponge placed in the front of the 
inhaler is dropped the medicine to be inhaled. 

Small pocket inhalers containing medicated cotton may be used. 
A small glass tube is partly filled with cotton, and this is kept in place 
by perforated corks fixed in either end. Any of the medicaments 
named may be placed on this cotton, and the air inhaled through the 

Fig. 92. 




Evans' pocket inhaler. Half size. The finger of the patient may be placed over the opening 
marked 1 when exhaling, and over that marked 2 when inhaling. 

tube. A tube of this sort packed with crystals of menthol, and called 
a "Menthol Inhaler/' is largely sold at present. It is of value in acute 
colds. A useful modification of this straight tube is that of Evans. 
(Fig. 92.) In this apparatus the sponge in the bulb is wet with the 
medicament. 



522 



REMEDIAL MEASURES OTHER THAN DRUGS. 



There are on the market at the present time a large number of 
so-called vaporizers or nebulizers, which by the aid of compressed air 
force the medicament to be inhaled in a fine spray against the side 
of the glass containing it, in this manner still further comminuting it 



Fig. 93. 




Robertson's nebulizer attached to a tank of compressed air. The tubes are so arranged that 
one or all of the medicaments in the different bulbs can be delivered to the patient at one time. 
In addition to the tube which carries the nebulized drug to the patient there is an extra attach- 
ment for an atomizer, which is seen on the right-hand side of the figure. 

and causing it to escape from the bottle or bulb as an exceedingly 
fine vapor. The larger ones are supplied, as a rule, with compressed 
air from a force pump or large hand pump. The smaller ones are 



INHALATIONS. 



523 



worked by a small hand pump or rubber bulb. The forms employed 
largely by the writer are those of Robertson and Oliver. (See Figs. 
93, 94.) For the satisfactory use of these nebulizers the medicament 
had better be dissolved in an oily fluid. The following formula may 
be used in such apparatus in coryza or acute inflammation of the upper 
respiratory tract: 

1^— Menthol gr. xx (1.3). 

Camphorse gr. x (0.60). 

Alboleni (liquid) f Bj (30.0).— M. 

S — Place in the Debulizer and inhale the vapor several times a day. 



COn- 



A somewhat similar formula of even greater value than this ~ 
tains, in addition to the above, 2 to 5 grains (0.12-0.3) of chloretone, 



Ftg. 94. 




Oliver's nebulizer. 

which is useful in that it is anaesthetic and sedative to the mucous 
membranes. (See article on Peppermint.) Where the inflammation 
is very severe and acute, it is often well to substitute for the above 
formula the following one: 

3$ — 01. sassafras gr. iij (0.2). 

01. santali m v (0.3). 

Alboleni (liquid) f§j (30.0).— M. 

S. — Use in vaporizer. 

In such small amounts sandalwood oil is sedative. If we wish to 
use it as a stimulant expectorant, the quantity may be increased to 30 
minims (2.0). An even more stimulant inhalation in cases of chronic 
bronchitis is as follows: 



1^—01. eucalypti f5j (4.0). 

01. picis liquid f 3ij (8.0). 

Alboleni (liquid) . . . . . . . f 5j (30.0).— M. 

S. — Use in nebulizer. 



524 REMEDIAL MEASURES OTHER THAN DRUGS. 



INTRAVENOUS INJECTION. 

The intravenous injection of medicines is a method which is to be 
employed only under extraordinary circumstances and with only a few 
drugs. Thus in the case of pernicious malarial fever it may be advis- 
able to resort to an injection of quinine. (See Cinchona.) Under 
these circumstances the injection should be made into a vein in the leg, 
rather than one in the arm, as the drug under these circumstances 
does not reach the heart in so concentrated a form, and temporary 
cardiac depression is thereby avoided. 

The objections to intravenous injections are several. In the first 
place, the veins are apt to be collapsed and hard to find, and it is 
difficult to puncture one without wounding the opposite wall of the 
vessel. Again, phlebitis is a very probable sequel, and thrombosis and 
embolism are by no means impossible. 

It is needless to say that the solution of the drug which is injected 
into a vein should always be of a neutral or alkaline reaction in order 
to avoid coagulation of the blood. (For Saline Injections, see Trans- 
fusion.) 

KATAPHORESIS. 

By the term "kataphoresis" is meant a method having for its 
purpose the introduction into the body of drugs through the influence of 
galvanic electricity. Correctly speaking, kataphoresis is an osmosis of 
medicaments through the tissues, the osmosis being carried on by the 
galvanic current and the drug being carried through the tissues between 
the two poles. Quinine, cocaine, iodide of potassium, the various 
soluble salts of mercury, and chloroform and ether may be so used. 
The ordinary sponge or absorbent cotton tip of the positive electrode 
is to be saturated with the medicament to be used, and the constant 
current employed. The positive pole of the battery is placed over the 
affected part, and the negative pole at a little distance away. 

In cases of neuralgia, chloroform and alcohol, of each one-half, or 
even pure chloroform, may be employed, and in syphilitic nodules, 
when the patient's stomach will not tolerate drugs, kataphoresis with 
iodides over the part affected may be resorted to. The iodide of 
lithium is commonly employed in the strength of 5 per cent, in these 
cases. The strength of the current depends upon the size of the elec- 
trodes and the sensations of the patient. It is not necessary to use a 
stronger current than the patient can bear with comfort. 

LAVAGE. 

This is a term applied to washing out of the stomach in cases of 
gastric dilatation, chronic gastritis, and more rarely in cases of gastric 
carcinoma. It is particularly valuable in the two first-named condi- 



LAVAGE. 



525 



tions, not merely for its curative power, but also to rid the stomach of 
mucus and render it clean before fresh food is ingested. 

The liquid employed should always be warmed. For an adult 
a tube should be used of at least four and a half to five feet in length, 
of which eighteen inches pass into the mouth, the remaining portion 
reaching to the basin when lowered to allow siphonage. The ques- 
tion as to the variety of tube to be employed is a vital one, since a 



Fig. 95. 




The stomach-tube having been 



the funnel is filled from a pitcher and elevated to urge 
the water into the viscus. 



poorly devised apparatus not only gives no relief, but disgusts both 
the patient and the physician with the technique of the method. The 
tube should be more like a hollow bougie than a catheter, in order 
that its calibre may be great enough to carry off some of the semi- 
solid materials present. If this rule is not followed, two evil results 
follow: In the first place, the tube and its apertures rapidly, or even 






526 



REMEDIAL MEASURES OTHER THAN DRUGS. 



at once, become clogged; secondly, the liquid is drained away leav- 
ing behind a mass which is semisolid, to be sure, and less bulky, but 
which is nevertheless the quintessence of the nastiness of fermentation, 
and quite as qualified to contaminate any fresh food on its entrance 
as the liquid would be. 

The holes in the gastric end of the tube should therefore be of suffi- 
cient size to take in fairly large masses. In most cases the ordinary 
siphon may be used, but where there is any solid food or resistance 
suction by means of a stomach-pump is necessary. 







Fig. 96. 




» 




t-^ ■ * 




_A 


1 


WBgjjm^ 




| vg 












JnfSz: ^BB 


R 


' ef * fH 




fltfi -*^P* 


I 

¥9 Wp 


HmSI 










JSP 










*^|k.' - szzZ&tF 




'm*~ 






„ _j 



Just as the last portion of the water is about to disappear down the tube the funnel end is 
lowered and the contents of the stomach are siphoned out. 

The best tube for adults is No. 10, made of red Para rubber with 
lateral holes. 

The methods by which lavage is employed, in addition to those which 
have been named, are as follows: The tube should be passed back- 
ward against the roof of the mouth, so that by following the curve 
of the hard and soft palates it is directed into the pharynx and 
oesophagus, and then by gentle pressure forced into the stomach. At 
the same time the patient should be directed to swallow. The mucus 



LEECHING. 527 

in the throat sufficiently lubricates the tube, and oil is not to be used. 
If gagging is excessive, the pharynx may be first painted with cocaine. 
The irritability of the pharynx usually rapidly disappears, and it is 
surprising how quickly the patient becomes accustomed to the opera- 
tion, and submits to it without any feeling of discomfort. After the 
tube has reached the stomach a small funnel is to be fitted in its exter- 
nal end, which is then held above the head of the patient while water 
prepared in the way we have mentioned is poured into it until the 
stomach is filled, when the funnel end is lowered and the stomach is 
emptied by siphonage. 

The stomach-pump has one very serious disadvantage, which is 
present with even more force in the case of a child than in an adult — 
namely, the danger of injury to the coats of the organ. This appa- 
ratus is also more costly and cumbersome, and for children the siphon 
is powerful enough in its action to take away all excuse for the use of 
the more complicated apparatus unless the contents of the stomach 
are in bulk. 

It is particularly necessary in children, if a catheter is used and 
on account of the lack of intelligent aid and their liability to gulp, 
that every care should be taken that the tube does not slip entirely 
out of reach into the stomach; and for the prevention of this danger 
a string should be attached to the external end of the catheter before 
it is introduced, and the tube should always be at least thirty inches 
in length. 

LEECHING. 

Leeching is a method of abstracting blood for the purpose of reliev- 
ing local inflammations or acute congestions. There are two forms 
of leech commonly employed in medicine, both of which are imported. 





Fig. 97. 






* 


i 




■ 









Showing the application of leeches in front of and behind the ear, for the relief of the early 
stages of acute otitis. The auditory meatus is plugged with cotton to prevent the leech from 
entering the canal by accident. 

A small leech is found in many streams in the United States. Leeches, 
after attaching themselves to the skin by means of their sucking appa- 
ratus and teeth, secrete a liquid which prevents coagulation of blood, 



528 REMEDIAL MEASURES OTHER THAN DRUGS. 

and this accounts for the persistent hemorrhage sometimes seen after 
a leech-bite. 

Therapeutics. — The reasons for using venesection or depletion 
are considered further on, and we can therefore pass directly to the 
uses to which leeches are put. In cases of meningitis they may be 
applied to the temples or to the nape of the neck, and they are useful 
in the treatment of swollen joints, such as occur after sprains. In 
orchitis they should not be placed upon the scrotum, but on the peri- 
neum. In conjunctivitis or inflammation of the eye they should be 
applied upon the temple or back of the ears, not upon the lid itself. 
The effect of leeching is not only that of depletion, but also one 
of count erirritation. 

Application. — Leeches if singly applied may be placed on the skin 
under an inverted wineglass or under a large pill-box to prevent them 
from migrating before they take hold. If they will not take hold, a 
little sweetened milk may be placed on the skin or a drop of blood 
extracted from the finger may be placed there. In all cases the skin 
should be carefully washed before the leech is used. When the leech 
has taken enough blood, it can be made to let go its hold by sprinkling 
it with salt. Each leech will take about 1 drachm of blood. Leech- 
bites should be washed lest prolonged consecutive bleeding exhaust 
the patient. In case of such an accident a compress and styptics are 
to be employed. As leech-bites make small permanent scars, the 
creature should not be applied on the face or other exposed surface 
of the skin. 

REST CURE. 

The rest cure, so called, is a method devised and elaborated by Dr. 
S. Weir Mitchell, of Philadelphia, for the relief of a large class of 
patients who, for various reasons, are generally ailing from apparently 
no organic disease, and yet whose condition is often so alarming as to 
lead to the belief that some hidden cause of a severe train of symptoms 
must be present. In many such instances a careful study of the case 
will show that there is a cause, near or remote, which has exhausted 
the patient's vital forces without producing anything else than func- 
tional disturbances of the body. Thus a prolonged nerve-strain in 
nursing a sick relative may so exhaust the strength of a hitherto healthy 
woman as to produce hysteria, anaemia, and great disturbances of 
nutrition, or, in another instance, cause neuralgia, disordered menstru- 
ation, and uterine or ovarian pain. In males mental, sexual, or 
physical vigor may be impaired, owing to prolonged anxiety in busi- 
ness. Be the symptoms what they may, as long as they are depend- 
ent upon nerve-strain, this "cure" is to be resorted to, and if properly 
carried out is often attended with surprising results. Before describing 
the method in detail it is proper to state that its entire rationale rests 
upon the remembrance that every movement is an expenditure of 
force, and that a system which has already overdrawn its reserve fund 



BEST CUBE. 529 

of strength must be as careful with its funds that remain as a bank 
should be under the same circumstances. 

It having been decided that the rest cure is to be employed, the 
directions are given as follows: 

A bright, airy, easily cleaned, and comfortable room is to be selected, 
and adjoining it, if possible, should be a smaller one for an attendant 
or nurse. The patient is put to bed and kept there for from three to 
six weeks, as may be necessary, and during this time is allowed to see 
no one except the nurse and the doctor, since the presence of friends 
requires conversation and mental effort. The patient in severe 
cases must be fed by the nurse in order to avoid the expenditure of 
the force required in the movement of the arms. No sitting up in 
bed is allowed, and if any reading is done it must be done by the nurse, 
who can read aloud for an hour a day. 

In the case of women the hair should be dressed by the nurse to 
avoid any physical effort on the part of the patient. 

To take the place of ordinary exercise two measures are employed, 
the first of which is massage or rubbing of the body, the second elec- 
tricity. By the kneading and rubbing of the muscles and skin the 
liquids in the tissues are absorbed and poured into the lymph-spaces 
and a healthy blush is brought to the skin. This passive exercise is 
performed in the morning or afternoon, and should last for from a 
half to one hour, every part of the body being kneaded, even the 
face and scalp. In the afternoon or morning the various muscles 
should be passively exercised by electricity, each muscle being made 
to contract by the application of the poles of the battery to its motor 
points, the slowly interrupted current being used. Both these forms 
of exercise do not call for any expenditure of nerve-force, though they 
keep up the general nutrition. The following programme for a day's 
existence is an example of what the physician should order: 

7.30 a.m. Glass of hot or cold milk, predigested, boiled, or raw 
as the case requires. 

8 a.m. The nurse is to sponge the patient with tepid water or with 
cold and hot water alternately, to stimulate the skin and circulation, 
the body being well wrapped in a blanket, except the leg or portion 
which is being bathed. After this the nurse should dry the part last 
wetted with a rough towel, using some friction to stimulate the skin. 

8.30 a.m. Breakfast. Boiled, poached, or scrambled eggs, milk 
toast, water toast, or a finely cut piece of a mutton-chop or chicken. 

10 a.m. Massage. 

1 1 a.m. A glass of milk, or a milk-punch, or egg-nog. 

12 m. Reading for an hour. 

1 p.m. Dinner. Small piece of steak, rare roast beef, consomme 
soup, mutton broth, and any one of the easily digested vegetables 
well cooked. 

3 p.m. Electricity. 

4.30 p.m. A glass of milk, or milk-punch, or egg-nog. 

34 



530 REMEDIAL MEASURES OTHER THAN DRUGS. 

6.30 p.m. Supper. This should be very plain, no tea or coffee, but 
toast and butter, milk, curds and whey, or a plain custard. 

9.30 p.m. A glass of milk or milk-punch. 

In this way the day is well filled, and the time does not drag so 
heavily as would be thought. If the stomach rebels at overfeeding, 
the amounts of food must be cut down, but when all the effort of the 
body is concentrated on respiration, circulation, and digestion a large 
amount of nourishment can be assimilated by the exhausted body, 
which before this treatment is undertaken may have had its resources 
so shattered as to be unable to carry out any physiological act per- 
fectly. 

For the treatment to be successful the rules laid down should be 
rigidly followed, and the cure should last from three to six weeks or 
longer. 

MINERAL SPRINGS AND CLIMATE. 

This article is intended to give the practitioner and student a gen- 
eral idea of where to send patients who can afford to resort to treat- 
ment depending upon watering-places and climates. It is manifestly 
impossible to include the names of all the health resorts, and the 
object is to indicate the diseases which are benefited by these treat- 
ments, taking certain well-known resorts as types of each class. 

Springs. 

Medicinal springs are usually resorted to for the double purpose 
of drinking and bathing in the waters, although in many instances 
one of these methods so far exceeds the other in popularity that it 
alone is employed. 

For general purposes we may divide these medicinal or beneficial 
waters into four classes — namely, those which act, first, by their 
purity chiefly; second, by the presence of more or less active alkaline 
ingredients; third, by the heat which the waters contain as they 
leave the earth; and, fourth, by reason of the sulphur and iron which 
they contain. The first class — namely, those which act by reason of 
their purity — are indicated chiefly in cases where through high living 
or other cause the system becomes laden with impurities through 
imperfect elimination of tissue-waste. Most of the popular lithia 
waters depend chiefly upon this ability to dissolve effete materials, 
and very little upon the lithia, which is often present in very small 
amount. (See Lithium.) Aside from their purity, they also act by 
reason of the salts of sodium and calcium which they contain. Good 
results follow their use in the so-called uric-acid diathesis where the 
urine is scanty, high-colored, and acid. They do good in cases of 
irritable bladder by washing out this viscus with mild urine in large 
quantities, and because of this influence are credited with wonderful 
cures of vesical calculus. When vesical calculi have broken down 
while these waters were being taken, the fortunate result has been 



MINERAL SPRINGS AND CLIMATE. 531 

coincidence rather than due to medicinal interference. It is impos- 
sible for them to dissolve stones, but their constant use may prevent 
the formation of new ones. Perhaps the best representative of such 
waters is Londonderry lithia water. 

A subdivision of this class consists of those waters which contain 
somewhat larger amounts of mineral substances, chiefly potassium, 
sodium, and calcium salts. Because of the power possessed by alka- 
line salts in aiding in oxidation, these waters are used in cases where 
the effete matters of the body seem to escape only partly oxidized, and 
where the kidneys, and perhaps the liver, seem torpid. Such springs 
are the Kissingen and Vichy at Saratoga. If very mild purgative 
properties are also desired, the Geyser Spring at Saratoga may be 
used. In Europe the most famous springs of this class are at Vichy 
(Grande Grille), Vals, and Contrexeville in France, and Kissingen 
in Bavaria. 

The second class of springs are those which contain salts of sodium, 
calcium, potassium, and magnesium in sufficient amount to possess 
very active diuretic and purgative properties. They find their thera- 
peutic application in cases of hepatic torpor or congestion associated 
with gouty or rheumatic tendencies, particularly in those individuals 
who have been high livers, who lay on too much fat, so clogging their 
organs, and, finally, in those who through illness or exposure to hot 
climates have subacute or chronic atony of the liver, of the organs 
of digestion, and of the lymphatics. Nearly always these patients 
also suffer from more or less constipation and gastrointestinal catarrh, 
and are often obese. The sulphate of sodium is an ingredient of 
many purgative mineral waters, and the activity of a water depends 
very often on the percentage of this salt which is present. The pur- 
gative action of a water also depends upon the time at wmich it is 
taken. When taken on an empty stomach it is of course more active. 
When taken early in the morning before eating and at the natural 
temperature, such a water produces a loose watery movement, not 
only unloading the bowel of fecal matter, but by its alkalinity loosen- 
ing catarrhal secretions and unloading the liver of congestion. The 
quantity to be taken in twenty-four hours varies from 1 to 4 pints, 
but this question can only be decided by the local physician, who 
studies the effect of the water on the patient. The best-known waters 
of this class are the Champion, Congress, Hathorn, and Carlsbad 
Springs at Saratoga, New York, the Crab Orchard in Kentucky, and 
the springs of Carlsbad and Marienbad in Bohemia, and Friederich- 
shall in Germany. 

The hot springs depend chiefly on their heat, as already stated, 
and differ in chemical composition. They find their value in the 
treatment of chronic skin diseases, specific or otherwise, and also are 
useful in aiding in the treatment of rheumatism, gout, and syphilis. 
Their good results are produced by their heat, which varies from 
93° to 150° F., and the advantages always derived from properly 



532 REMEDIAL MEASURES OTHER THAN DRUGS. 

employed hydrotherapeutic measures. It is in chronic or subacute 
cases that they do the most good. Hot baths are also of great value 
in the treatment of chancroid and malignant syphilis. The results 
achieved depend upon the increased activity of the skin, the improve- 
ment of the peripheral circulation, and the increased powers of absorp- 
tion produced through increased cellular activity. 

Patients should always select a competent local physician at such 
resorts. 

In cases of syphilis the methods of treatment to be followed are as 
follows: The patient should take the bath at a temperature of 90° F., 
and remain in it for about twenty minutes. After this he is rapidly 
but thoroughly dried by an attendant, who at once proceeds to rub 
into the skin of one thigh an amount of mercurial ointment varying 
from a few grains to a drachm. This is well rubbed into, not smeared 
over, the skin of a different limb after each bath. The number of 
baths and inunctions depends upon the condition and necessities of 
the case, care being exercised not to push the mercury too freely in 
those who are very susceptible to its effects. These baths also aid in 
the absorption of mercury when it is administered by fumigation. 

The most celebrated of these springs are the Hot Springs of Arkansas 
and those found at Aix-la-Chapelle (Aachen) in Germany. 

As types of the fourth class of springs we have the White Sulphur 
Springs in West Virginia and the Richfield Springs in New York, 
which are used for the relief of catarrhal inflammations of the mucous 
membranes of the alimentary canal and respiratory passages, and 
more rarely for catarrhal states of the genito-urinary tract. Not 
only do they exert the peculiar remedial powers long known to belong 
to sulphur and its compounds by reason of the sulphuretted hydrogen 
gas contained in them, but they also possess distinct purgative effects. 
Their chief mineral constituents consist of sulphate of sodium and 
magnesium, which unload the bowels and portal system in the same 
manner as do the Champion, Congress, Hathorn, and Carlsbad 
Springs at Saratoga and those at Crab Orchard. Taking the White 
Sulphur as a type of its class, it is better than the Saratoga springs 
in catarrhal states for the reasons given, 

Rockbridge Alum Spring in Virginia is used in cases of chronic 
diarrhoea with very useful results in many cases. It is not so useful 
in acute inflammations of the intestine as in the diarrhoea due to 
chronic disorder. As iron is present in it and in most alum springs 
in considerable amount, this water is useful in anaemic cases, but is 
contraindicated by fevers, by chronic congestions, chiefly of the liver, 
and by plethora. Often in place of alum we find salines associated 
with the iron, and these waters are particularly indicated in the catarrhs 
associated with anaemia. Such a spring exists at Bedford, Pennsyl- 
vania. In Europe the chief iron springs are at St. Moritz in Switzer- 
land and Tunbridge Wells in England. Neither of these contains 
much sulphur or alum. 



MINERAL SPRINGS AND CLIMATE. 533 

Climates. 

The practitioner is most frequently consulted as to the possible 
benefit of climatic changes by persons suffering from pulmonary dis- 
ease, such as tuberculosis of the lungs, asthma, chronic bronchitis, 
and emphysema — more rarely by those convalescing from pneumonia 
or other severe acute illness. 

The general rules to be followed in all cases are — first, choose 
a climate having as large a number of clear days as possible, in order 
that an out-of-door life in the sunshine may be hacl constantly; sec- 
ondly, the nearest place to the home which is available in order to 
avoid fatigue, expense, and home-sickness; and thirdly, see that the 
resort chosen has comfortable accommodations, good food, good 
drug-supplies, and a capable physician at hand in case of need. 

In a case of tuberculosis and in all patients suffering from the pul- 
monary complaints named above the following rules may be adhered 
to, except in persons suffering from attacks of acute bronchitis, who 
always need a climate providing moisture and warmth. Some tuber- 
cular patients do best in a high, dry air, and others in a lower and 
more moist temperature — the first being represented by that of Colo- 
rado Springs (6000 feet) in America and by San Moritz (6000 feet) and 
Davos Platz (5000 feet) in Switzerland, where the altitude is not only 
very great, but the air very cold in winter. The days in these places 
are many of them clear, but in Colorado they are apt to be windy. 
Feeble persons cannot stand high winds, as a rule. The second 
climate is represented by that of Florida. 

In many cases, however, some more moderate climate is useful, and 
this can be obtained in Southern California, as at San Diego, a place 
where there is virtually perpetual summer, or at Asheville, N. C. 
(2200 feet), or Thomasville, Georgia (330 feet), where the air is mod- 
erately dry. In other words, a spot is desirable where a patient can 
remain the year round, and, if well enough, engage in business, avoid- 
ing the cold, sharp March winds of the Middle, Eastern, or North- 
western States, and the necessity of leaving Florida on the advent of 
summer. 

Physicians have attempted for years to formulate rules for phthis- 
ical patients as to the climate to be sought. In very many cases the 
various health resorts have to be chosen by experiment, not by judg- 
ment beforehand. In cases of phthisis with profuse bronchial secre- 
tion, a high, dry climate is generally the better unless the heart is 
feeble, but in cases which suffer from dryness of the air-passages a 
sea-voyage or a warm, moist climate is better, on general principles. 
It is probably true, however, that high altitudes and rarefied air are 
not to be sought where a distinct tendency to hemorrhage is present, 
unless the ascent or removal to the rarefied air is very gradual, several 
weeks being passed before the lung is exposed to the low pressure of 
great heights. The cases in which high altitudes do good are those 



534 



REMEDIAL MEASURES OTHER THAN DRUGS. 



which naturally have poor thoracic development or suffer from chronic 
pleurisy with deficient expansion of the lung after tapping. The 
following excellent advice given by White in his General Therapeutics, 
is worthy of repetition: 

"It is of such importance that only suitable cases should be sent 
to high altitudes that we must point out those that are unsuitable : 

"1. Those in whom there is considerable affection of the bronchial 
tubes, for the dryness of the climate increases the kind of bronchitis 
which commonly accompanies phthisis. 

"2. Patients with much emphysema or bronchiectasis, because of 
the probably diminished absorption of oxygen and the difficulty of 
respiration experienced on first arriving. 

"3. Patients with disease of the heart must not go to a high alti- 
tude, because of its effect upon the pulse and upon respiration. 



Fig. 98. 




Chest outline before residence at Davos 



After residence at Davos 



(Williams' diagram.) 

"4. Cases liable to acute febrile attacks, whether or not these 
indicate an occasional increase of mischief in the lungs, should remain 
on a low level. 

"5. Patients who are very excitable or suffer from insomnia should 
not go, for a visit to a place at a great elevation promotes these symp- 
toms. Women do not acclimatize so well as men. 

"6. Cases in which there are very extensive lesions, or which are 
very advanced, are unsuitable. 

"7. Pneumonic phthisis, if at all acute, is made worse by a high 
altitude. 

"8. Patients who cannot take exercise should not go. 

"9. The very old and the very young had better be treated at home. 

"10. Sir Andrew Clark (London Lancet, January 5, 1889) states 
that patients who go to Alpine health resorts suffering from albumin- 



MINERAL SPRINGS AND CLIMATE. 535 

uria, or those who develop it whilst there, seldom derive any good 
from their change. 

"There are many conditions which have been thought to contra- 
indicate this treatment, but which do not, and they had therefore 
better be mentioned. They are: 

" Pulmonary Hemorrhage. — It is now known that this, so far 
from being a contraindication to treatment by high altitudes, is actu- 
ally relieved by it. The exact explanation cannot be given." 

With this the author of this work cannot agree. 

"Fever. — If this is not excessive, and if it does not indicate any 
active changes in the lungs, it is often improved. 

"Simple Diarrhcea and Simple Dyspepsia. — These are both 
benefited. 

"Night-sweats. — There is a common belief that these forbid this 
treatment; on the contrary, they often disappear on removal to a high 
altitude. 

"The Presence of Cavities. — This is not a contraindication 
unless a very large area of lung is destroyed." 

There is no need, after these two lists, to say what cases are suit- 
able for this climatic treatment: it may, however, be observed that 
those in whom there is threatened phthisis, with a strong hereditary 
predisposition, and those of imperfect thoracic development, are 
much benefited. According to most authorities, it cannot be too 
strongly urged that so long as the condition and disease of the patient 
allow the reverse indications to be neglected a mountain climate should 
be tried. 

To these rules the author would add the following invariable rule: 
viz., Do not send a case away to die. If the disease is so far advanced 
that no good can be derived from a trip abroad, it is cruel to make a 
wretched patient exhaust his strength, his money, and his happiness 
by seeking health which it is impossible for him to obtain. A patient 
of the writer's returned on one occasion from a stay of a few days at 
a noted Southern resort for consumptives, and, when reprimanded 
for his imprudence, replied: "I would rather be at home, and die at 
once, than drag out a few more years surrounded by a crowd of cough- 
ing, hawking, and wasting consumptives." This reply evidences 
clearly the necessity of avoiding "consumptive resorts" as much as 
possible in these cases, and in directing the mind of the patient from 
depressing thoughts and his own ailment, and that he may avoid 
secondary infection from other sufferers. 

In the treatment of renal and cardiac disease high altitudes are 
contraindicated, as a rule. The chief desideratum is out-of-door life 
with avoidance of chilling of the skin by sudden changes in tempera- 
ture or strong winds. San Diego represents the necessary climate in 
such cases. 

There is a class of persons who often have no actual disease of a 
chronic type, who nevertheless pass healthier lives if away from rig- 



536 REMEDIAL MEASURES OTHER THAN DRUGS. 

orous climates for at least part of the year. Without having acquired 
tuberculosis, their lungs are delicate naturally or because of attacks 
of disease, or, again, they become asthmatic or rheumatic in cold 
weather. In this country Asheville, N. C, and Thomasville, Ga., or 
San Diego or Coronado Beach, California, afford the climate desired, 
while in Europe patients are sent to what is known as the "Riviera," 
which is the district bordering on the Mediterranean Sea from Genoa 
to Nice and which is dotted with climatic resorts. This district has 
often as many as two hundred clear days between October 1st and 
May 1st. In the French Riviera the resorts are Cannes, Nice, Monaco, 
Monte Carlo, and Mentone: in the Italian Riviera, Bordighera and 
San Remo. In Naples and Spezzia the climate is more damp and 
colder, but nevertheless quite sunny. So much depends upon the loca- 
tion of the hotels in these places, as far as their salubrity in relation to 
air and dampness is concerned, that the patient should always con- 
sult a local physician before settling down permanently at any of these 
resorts. 

SUSPENSION. 

The treatment of locomotor ataxia and allied affections by means 
of suspending the patient was for a time very popular, but it has now 
largely gone out of use. The method was not confined to cases depend- 
ing upon diseases of the vertebra? producing lesions in the spinal cord, 
but was also thought to be useful in instances where the lesion was 
primarily situated in the nervous tissues. 

The patient should use one of the apparatuses made by many makers 
of surgical instruments, which consists in a cushioned head-strap 
and a cushioned leather loop for each axilla. The traction on the 
head should not be sufficient to cause discomfort; in other words, the 
weight of the patient should be equally distributed between the shoul- 
ders and the head. A rope is run from the harness to a pulley in the 
ceiling, and by this means the patient may be slightly raised from his 
chair — say two inches — once a day, for thirty seconds at first, which 
may gradually be increased to ten minutes. The swinging should be 
resorted to at first every second or third, and finally every, day. If 
several pulleys are put in the circuit of rope, the patient can soon learn 
to lift himself, making the rope fast to a cleat in a heavy chair or table, 
or even holding it in the hands. It is important that the patient, 
after each swinging, should rest for thirty minutes to an hour, and 
when let down to his chair the movement should be most gentle and 
not jerking or sudden. The same rule as to gentleness applies to 
the raising of the patient. 

TRANSFUSION. 

The term Transfusion was originally applied in medicine to the 
transference of blood from a healthy person (the donor) to the sick 
patient (the receiver), who was usually suffering from the results of 



TRANSFUSION. 537 

profuse hemorrhage. When direct transfusion was not resorted to, the 
blood was defibrinated after being drawn from the arm of the donor 
and the serum injected into the vein of the sick man. Both of these 
plans are now practically obsolete, for it has been proved that the 
blood-corpuscles of the donor always die in the vessels of the receiver 
and the kidneys are overwhelmed in an effort to eliminate the results 
of their destruction. Further, it is almost impossible to perform 
transfusion of pure or defibrinated blood without producing clots which 
will form emboli in the vessels of the patient. Finally, we now know 
that the blood-serum of one man differs greatly from that of another 
in its physiological effects, and is not to be regarded as identical- with 
the serum that is lacking in the patient. The use of milk as a trans- 
fusion fluid has been found to result in albuminuria, in infections of 
various kinds, and in the development of emboli. It ought never to 
be used for this purpose. 

At the present time the profession employ a saline solution, injected 
gently into a vein of the arm or leg, not only to overcome the collapse 
of hemorrhage, but — far more important — for the relief of various 
forms of toxaemia. Commonly in hemorrhage and in toxaemia 'hypo- 
dermoclysis is used, as already described, because the danger of embo- 
lism and the possible results of opening a vein are not to be disre- 
garded. Therefore, while hypodermoclysis is the safest and preferable 
method ordinarily, on the other hand when the case is very urgent, or 
the tissues are cedematous from dropsy, or the circulation is so feeble 
that absorption is impossible, then the intravenous or endogenous in- 
jection is to be employed without hesitation. 

Various formula? exist for the preparation of the so-called normal 
saline solution. Some persons are satisfied to employ the ordinary 
solution of common salt in the strength of 0.7 per cent. (I7 drachms 
to the quart), in distilled and sterilized water. Others prefer to use a 
formula suggested by the well-known French clinician, Prof. Hayem, 
as follows: 

Sodium sulphate 10.0 

Sodium chloride 5.0 

Distilled water 1000 c.c. 

A still better solution, however — because it at once supplants the 
blood which has been lost or is impure, and because it supports the 
heart — is : 

Calcium chloride 0.25 

Potassium chloride . . . . . .0.1 

Sodium chloride 9.0 

Sterilized water . 1000 c.c. 

At the author's suggestion, there is now placed upon the market a 
concentrated saline solution in which the salts just named are dis- 
solved in one ounce of sterile water and placed in a sealed sterile bottle. 
The contents of one of these vials added to 1 quart (1000 c.c.) of pure 
sterile water make a normal saline fluid ready for instant use. 



538 REMEDIAL MEASURES OTHER THAN DRUGS. 



• 



The method of injection is as follows: The thoroughly sterilized 
saline solution, after being warmed to the temperature of 101° F., is 
placed in a warm glass irrigation flask. The patient's skin over the 
elbow is bared and sterilized; the skin over one of the veins, which is 
made prominent by a bandage about the upper arm, is incised by a 
scalpel, and the sheath of the vein raised by means of a pair of dis- 
secting forceps. This sheath is thoroughly dissected off the vein 
until this vessel lies free from any attachments for the space of half an 
inch. A small and gentle bull-dog clip is applied on the vein at the 
proximal end of the incision so as to keep the lower part of the vein 
full of blood. A ligature is now passed around the vein at the distal 
end of the incision and tied. Another ligature is then passed under 
the vein and left untied. The distended area of the vein, between 
the ligature which has been tied and the clip, is now snipped by means 
of a pair of fine scissors ; and a glass canula, previously dipped in the 
saline solution to prevent the few drops of blood from coagulating on 
its tip, is inserted into the opening in the vein. The loose ligature is 
now tied around it and the vein, to hold the canula in place. This 
canula should have a shoulder at its tip to prevent the ligature from 
slipping off, and its other end should be attached to a piece of sterile 
rubber tubing not more than four inches long. By means of a steril- 
ized glass pipette some of the saline is now run into the rubber and 
glass canula until all air is displaced and they are filled to the utmost. 
The saline is then allowed to flow out of the tubing attached to the 
irrigator, which is armed by a glass tip, till all the air is displaced, 
when one tube is slipped inside the other. By this means all danger 
of air embolism is excluded. The irrigator is now held about two 
feet above the arm and the fluid allowed slowly to enter the vein, a 
half-hour being spent in injecting about a quart. (Fig. 99.) As the 
injection is given the pulse begins to improve, the respirations are 
deeper and less hurried, and if fever is present the temperature usually 
falls. The patient is evidently better, but soon enters the critical 
stage, which may come on in from two to thirty minutes. There are 
sometimes a violent chill, a strong, rapid pulse, and in the course of 
three-quarters of an hour a flushing of the skin, followed by a profuse 
sweat. The respiration may be labored. The urinary flow is also 
increased, and sometimes water escapes from the bowel. Several 
hours later the real benefit appears in convalescence or in marked 
improvement. 

The conditions in which the intravenous injections are to be per- 
formed are severe hemorrhage, toxoemia arising from the various forms 
of infection, as in septicaemia, uraemia, and the comatose state in dia- 
betes mellitus. They can be employed in threatened eclampsia, and 
even in the toxaemias of the infectious fevers. 

The author has used them in uraemic and septic intoxication with 
the best results. The principle of this treatment is that it causes the 
rapid elimination of impurities from the body. 



TRANSFUSION. 



539 



This method is to be regarded as a fairly promising mode of treat- 
ment for cases otherwise doomed to death, and will afford permanent 
or temporary relief according to the severity of the underlying dis- 
ease. When diabetes exists or Bright's disease is present, the benefit 



Fig. 99. 



Fig. 100. 





Fig. 101. 



Two types of apparatus used for hypodermoclysis and for the intravenous injection of saline 
solution. The flow of liquid in the rubber tube leading from the container is controlled by a 
clip. A large antitoxin needle like that shown in Fig. 99 may be used, or a trocar and canula, 
as in Fig. 101. The needle only is needed for hypodermoclysis. 



is often only temporary. The European clinicians are loud in their 
praises of the results they have obtained by this plan in the various 
forms of sepsis. In uraemia and in puerperal convulsions the patient 
should be bled if the arterial tension is high. 

Abdominal transfusion of both saline solutions and milk have been 
successfully carried out, the reason being that the peritoneal cavity is 
a vast absorbent surface which rapidly takes up liquids if the systemic 
vessels are not so full as they normally should be. The method con- 
sists in puncturing the abdominal wall as if for aspiration for dropsy. 
The tube from a hydrostatic syringe is now attached to the canula, 



540 REMEDIAL MEASURES OTHER THAN DRUGS 

and the liquid, having been warmed, is allowed slowly to flow into 
the belly. This method is not to be relied on where death seems 
very imminent, and the use of milk is dangerous. There is also some 
danger of perforating the bowel wall. 

VENESECTION. 

Bleeding, or Phlebotomy, is so rarely practised to-day that very 
many of the profession have never abstracted blood for therapeutic 
purposes or have even seen it done by some one else. Furthermore, 
it is to be feared that many of the younger physicians' would hardly 
know how to bleed if called upon to do so at a crisis. All this is 
wrong, for bleeding is a measure undoubtedly of the greatest value, 
and one which every physician may be called upon to resort to. Like 
many therapeutic measures, it was sadly abused in the early part 
of the last century, and people when taken ill were bled with the same 
regularity that they were put to bed. 

The indications for venesection are as clear and well defined as are 
the indications for any remedy. Briefly stated, we may say that all 
states of the circulatory apparatus denoting high arterial tension and 
excitement are indications, and that weakness, low arterial tension, 
and systemic or circulatory depression are contraindications. Since 
the use of veratrum viride has become more common, the conditions 
indicating venesection have been lost sight of, because this drug so 
dilates the bloodvessels that a man is bled into his own bloodvessels. 

Having made clear the general indications for the use of venesec- 
tion, we may pass on to state some of the diseases in which it may be 
well resorted to. Of these, certain cases of pneumonia, pleurisy, 
meningitis, and peritonitis, if they are sthenic, are typical examples, 
since all of them are accompanied by arterial excitement and charac- 
terized by local congestions affecting the lung, pleura, cerebral mem- 
branes, or peritoneum. (See Pneumonia.) By the abstraction of 
blood the vascular tension is lowered and the engorged area relieved. 
In the first place, the congested area is made up of relaxed blood- 
vessels, whereas the remaining bloodvessels of the body are tense, and, 
as a consequence, the blood is urged to the spot already engorged. In 
the second place, the abstraction of blood from the tense bloodvessels 
renders the general pressure lower than that in the diseased area, and 
the congestion is relieved. 

In apoplexy the extravasation of blood into the brain causes great 
arterial excitement, and free venesection has been commonly per- 
formed to relieve this state. Recent studies by Cushing, however, 
indicate that bleeding under those conditions is contraindicated. (See 
Apoplexy.) 

The method by which venesection is practised is yet to be described. 
It is a very simple operation if an assistant is present to make pressure 
on the vein or entire arm. Often this pressure is best exercised by 



VENESECTION. 541 

means of a handkerchief or bandage tightly twisted about the arm 
above the spot where the incision is to be made. Under these circum- 
stances the veins of the arm become prominent and distended, and 
one of them may be readily bared by a short longitudinal incision of 
half an inch, the fascia being separated until the glistening blue sur- 
face of the vessel appears free from fat or connective tissue. Into 
this vessel, with the edge of the knife turned upward, a small longi- 
tudinal incision is made, care being taken that the point of the blade 
is not driven in far enough to injure the posterior wall of the vein, or a 
pair of scissors is used and the vessel is nipped. If a clot forms and 
stops the flow, it must be removed by an aseptic cloth, while if the 
flow is to be stopped we may remove the bandage above and apply 
a compress over the incised vein, the compress being held in position 
by a bandage. Care should always be taken that the bandage on the 
upper part of the arm is not so tight as to cut off all blood-supply to 
the arteries of the lower part of the limb. 



FEEDING THE SICK, 



In the opening pages of this work the importance of properly feed- 
ing the sick has already been emphasized. It is manifestly impossible 
for the writer to go into details concerning the deep and difficult prob- 
lems of the changes in the food when taken into the body for assimila- 
tion. At this point it is necessary only to recall that the foods taken 
by man consist in proteids, carbohydrates, and hydrocarbons. In the 
albuminous or proteid articles of food nitrogen is a prominent con- 
stituent, and the type is egg-albumin. While most nitrogenous foods 
are animal in source, it must not be forgotten that gluten and legumen 
are nitrogenous and derived from vegetables. The carbohydrates 
consist of substances in which carbon, hydrogen, and oxygen are com- 
bined, the hydrogen and the oxygen in the proportion to form water, 
of which the types are starch, dextrin, cane-sugar, grape-sugar, lactose 
or milk-sugar. The hydrocarbons are composed of carbon, hydrogen, 
and oxygen, but the proportion of oxygen is insufficient to convert all 
the hydrogen into water. The types of this group are butter and 
other fats. 

The function of the proteid, or albuminous, foods is to contribute to 
the repair and formation of the body tissues, particularly those which 
are nitrogenous; they also contribute to the development of muscular 
and nervous energy and the production of heat, being split up into 
nitrogenous and non-nitrogenous parts, from the last of which fat 
may be formed and deposited or burnt up in the development of force. 

The carbohydrates are split up in the body into carbonic acid and 
water, and in this process yield heat and energy. Unlike the proteids, 
they do not enter the tissues of the body unless it be that they are con- 
verted into fat. By reason of the heat and energy which they con- 
tribute to the economy they protect the albumins and fats from demands 
which would otherwise be made upon them for these purposes. 

The hydrocarbons, or fats, are employed in the body to yield force 
and heat, and are stored up in the form of fat, so as to act as a reserve 
in case of need, so that by their use the albuminous portions of the 
body are saved from demands upon them. For these reasons hydro- 
carbons and carbohydrates can be well taken in large quantities by 
those who take much exercise, but are harmful if partaken of largely 
by persons leading sedentary lives. 

It is manifest, therefore, that for the maintenance of health we must 
(542) 



FEEDING THE SICK. 543 

provide a patient, not with nitrogenous or carbohydrate foods alone, 
but with some of all the food articles, regulating the proportions of 
each to his needs and his ability to utilize them after they are ingested. 
The practical application of these facts is as follows : 

In fevers, in which there is an active wasting of the tissues of the 
body, we give albuminous foods to replace the tissues destroyed or to 
make up for their loss, and these consist of broths, soups, eggs, milk, 
and the gelatinous substances which, while not very nutritive, are 
what are known as "albumin-sparing" substances. As the secretion 
of the gastric juice is faulty in nearly all fevers, it is important to give 
these foods in semiliquid or liquid form, so that they can be readily 
digested, and we often aid their digestion by the use of pepsin and 
hydrochloric acid. 

As carbohydrates and hydrocarbons add force or energy to the 
body, and in their combustion protect the albuminous tissues, they 
also must be used, particularly the former. There is no doubt that 
physicians are far too prone to limit the patient's diet to proteids, and 
in the author's practice he invariably prescribes, in addition to the 
proteid foods, thin preparations of starch, such as strained rice, strained 
oatmeal, cracked wheat, and barley, aiding their digestion, if need be, 
with taka-diastase or pancreatin. 

In order that an approximate idea of the proportion of food-stuffs 
may be conveyed to the reader, it may be pointed out that the healthy 
human body must be provided in twenty-four hours with that amount 
of food which will yield his body 3650 calories. 1 This is best accom- 
plished by the use of the following proportions, according to Egleston : 
carbohydrates, 400 grammes ; fats, 150 grammes; proteids, 150 grammes. 
Nearly all food- stuffs contain the several classes of proteids, carbo- 
hydrates, and hydrocarbons in varying proportions. These are shown 
in the accompanying table, taken from Billings's Medical Dictionary, 
and it also shows the number of calories in each pound of the material. 
It is interesting to note how many more calories are provided by the 
hydrocarbons and fats than by the proteids, but it is also worthy of 
note that the proteids, while not providing calories, do provide the 
materials which are useful for the repair and growth of tissue. 

Water forms such an important part of the body that its free ingestion 
is advisable, if it is pure, in nearly all cases of disease. 

Having considered the general theory of feeding, we may now pro- 
ceed to the actual preparation of food for the sick. There are several 
important general facts to be borne in mind in this connection: 

1. The food, when prepared, must be capable of ready assimilation. 

2. It must be, as a rule, fairly concentrated in the sense of contain- 
ing great nutritive power in little bulk, since it is a mistake to weary 
a feeble patient with much swallowing. 



1 A calorie is the French unit of heat, or that amount of heat required to raise the tempera- 
ture of one kilogram of water one degree Centigrade. 



544 



FEEDING THE SICK. 



Percentages of Nutrients {Nutritive Ingredients), Water, etc., and Estimated Potential 
Energy [Fuel-value) in Specimens of Food-materials. 









Edible Portion. 






Nutrients. 


Calories 




Refuse : 
bones, 






of poten- 


FOOD-MATERIALS. 












tial en- 




skin, 














ergy in 




shell, etc. 


Water. 












one 








Total. 


Pro- 
tein. 


Fats. 


Carbo- 
hydrates. 


Mineral 
matters. 


pound 

of each 

material. 


Animal foods as purchased, 


















including edible portion, 


















and refuse: 


pr. ct. 


pr. ct. 


pr. ct. 


pr.ct. 


pr. ct. 


pr. ct. 


pr. ct. 




Beef, side 1 . . . . 


19.7 
10.0 


44.0 
60.0 


36.3 
30.0 


13.8 
20.7 


21.7 
8.1 




0.8 
1.2 


1170 


Beef, round 1 . . . 




725 


Beef, neck 1 . . . 




19.9 


49.6 


30.5 


15.4 


14.3 








0.8 


890 


Beef, sirloin x . . 




25.0 


45.0 


30.0 


15.0 


14.3 








0.7 


885 


Beef, flank * . . . 




11.7 


24.2 


64.1 


10.6 


52.9 








0.6 


2430 


Mutton, side 1 . . 




20.0 


42.9 


37.1 


13.2 


23.2 








0.7 


1225 


Mutton, leg 1 . 




18.4 


50.4 


31.2 


15.0 


15.5 








0.7 


935 


Mutton, shoulder 1 




16.8 


48.7 


34.5 


15.0 


18.7 








0.8 


1070 


Mutton, loin (chops) 


1 '. 


16.3 


41.3 


42.4 


12.5 


29.3 








0.6 


1470 


Smoked ham . . 




14.0 


36.3 


49.7 


14.6 


34.2 








0.9 


1715 


Pork, very fat . . 




10.4 


9.5 


80.1 


2.8 


76.5 








0.8 


3280 


Chicken 2 . . . . 




41.6 


42.2 


16.2 


14.2 


1.2 








0.8 


315 


Turkey ■ 




35.4 


42.8 


21.8 


15.4 


5.6 








0.8 


525 


Flounder, whole . 




66.8 


27.2 


6.0 


5.2 


0.3 








0.5 


110 


Haddock, dressed 




51.0 


40.0 


9.0 


8.2 


0.2 








0.6 


160 


Bluefish, dressed . 




48.6 


40.3 


11.1 


9.8 


0.6 








0.7 


210 


Brook trout, whole 




48.1 


40.4 


11.5 


9.8 


1.1 








0.6 


230 


Codfish, dressed 




29.9 


58.5 


11.6 


10.6 


0.2 








0.8 


205 


Whitefish, whole . 




53.5 


32.5 


14.0 


10.3 


3.0 








0.7 


320 


Shad, whole . . . 




50.1 


35.2 


14.7 


9.2 


4.8 








0.7 


375 


Turbot, whole . . 




47.7 


37.3 


15.0 


6.8 


7.5 








0.7 


445 


Mackerel, fat, whole . 


33.8 


42.4 


23.8 


12.1 


10.7 








1.0 


675 


Mackerel, lean, whole . 


38.3 


48.5 


13.2 


11.2 


1.4 








0.6 


265 


Mackerel, average, whole 


44.6 


40.4 


15.0 


10.0 


4.3 








0.7 


365 


Halibut, dressed . . . 


17.7 


61.9 


20.4 


15.1 


4.4 








0.9 


465 


Salmon, whole .... 


35.3 


40.6 


24.1 


14.3 


8.8 








1.0 


635 


Eel 


36.0 
42.1 


33.8 
40.3 


30.2 
17.6 


8.6 
16.0 


21.0 
0.4 








0.6 
1.2 


1045 


Salted codfish .... 


315 


Smoked herring . . . 


50.9 


19.2 


29.9 


20.2 


8.8 








0.9 


745 


Salted mackerel . . . 


40.4 


28.1 


31.5 


14.7 


15.1 








1.7 


910 


Canned salmon .... 


4.9 


59.3 


35.8 


19.3 


15.3 








1.2 


1005 


Canned sardines . . . 


5.0 


53.6 


41.4 


24.0 


12.1 








5.3 


955 


Lobsters 


62.1 


31.0 


6.9 


5.5 


0.7 


0.1 


0.6 


135 


Oysters in shell . . . 


82.3 


15.4 


2.3 


1.1 


0.2 


0.6 


0.4 


40 


Hen's eggs 


13.7 


63.1 


23.2 


11.8 


10.2 


0.4 


0.8 


655 


A nimed foods, edible portion. 


















Beef, side 1 




54.7 


45.3 


17.2 


27.1 




1.0 


1465 


Beef, round 1 . . . . 




66.7 


33.3 


23.0 


9.0 








1.3 


805 


Beef, sirloin x . . . . 




60.0 


40.0 


20.0 


19.0 








1.0 


1175 


Mutton, side J . . . . 




45.9 


54.1 


14.7 


38.7 








0.7 


1905 


Mutton, leg 1 . . . . 




61.8 


38.2 


18.3 


19.0 








0.9 


1140 


Mutton, loin (chops) 1 . 




49.3 


50.7 


15.0 


35.0 








0.7 


1755 


Flounder 




84.2 


15.8 


13.8 


0.7 








1.3 


285 


Codfish 




82.6 
64.0 


17.4 
36.0 


15.8 
18.2 


0.4 
16.3 








1.2 

1.5 


310 


Mackerel, fat .... 




1025 


Mackerel, lean .... 


. . 


78.7 


21.3 


18.1 


2.2 








1.0 


430 


Mackerel, average . . 


1 ' ■ 


71.6 


28.4 


18.8 


8.2 




1.4 


695 



1 From well-fattened animals. 



2 Rather lean. 



FEEDING THE SICK. 



545 









Edibli 


Portion 














Nutrients. 




Calories 




Refuse : 
bones, 














of poten- 


FOOD-MATEKIALS. 












tial en- 




skin, 














ergy in 




shell, etc. 


Water. 












one 








Total. 


Pro- 
tein. 


Fats. 


Carbo- 
hydrates. 


Mineral 

matters. 


pound 

of each 

material. 


Animal foods, edible portion 


" pr. ct. 


1 
pr. ct. pr. ct. 


pr.ct. 


pr. ct. 


pr. ct. 


pr. ct. 




Salmon 




63.6 


36.4 


21.6 


13.4 




1.4 


965 


Oysters, fat 




81.7 


18.3 


8.0 


1.7 


6.7 


1.9 


345 


Oysters, lean .... 




90.9 


9.1 


4.2 


0.6 


1.8 


2.5 


135 


Oysters, average . . . 




87.1 


12.9 


6.0 


1.2 


3.7 


2.0 


230 


Hens' eggs 




73.1 


26.9 


13.7 


11.7 


0.5 


1.0 


760 


Cows' milk 




87.4 


12.6 


3.4 


3.7 


4.8 


0.7 


310 


Cows' milk 




90.7 


9.3 


3.1 


0.7 


4.8 


0.7 


175 


Cheese, whole milk . . 




31.2 


68.8 


27.1 


35.5 


2.3 


3.9 


2045 


Cheese, skimmed milk . 




41.3 


58.7 


38.4 


6.8 


8.9 


4.6 


1165 


Butter . 




10.0 


90.0 


1.0 


85.0 


0.5 


3.5 


3615 


Oleomargarine .... 




10.0 


90.0 


0.6 


84.5 


0.4 


4.5 


3585 


Lard 




1.0 


99.0 




99.0 






4180 


Vegetable foods: 


















Wheat bread .... 




32.7 


67.3 


8.9 


1.9 


55.5 


1.0 


1280 


Wheat flour 




11.6 


88.4 


11.1 


1.1 


75.6 


0.6 


1660 


Graham flour . . . : 




13.0 


87.0 


11.7 


1.7 


71.8 


1.8 


1625 


Rye flour 




13.1 


86.9 


6.7 


6.7 


78.7 


0.7 


1620 


Buckwheat flour . . . 




13.5 


86.5 


6.5 


1.3 


77.6 


1.1 


1620 


Beans 




13.7 


86.3 


23.2 


2.1 


57.4 


3.6 


1585 


Oatmeal 




7.7 


92.3 


15.1 


7.1 


68.1 


2.0 


1845 


Corn (maize) meal . . 




14.5 


85.5 


9.1 


3.8 


71.0 


1.6 


1650 


Rice 




12.4 


87.6 


7.4 


0.4 


79.4 


0.4 


1630 


Sugar 




2.2 


97.8 


0.3 




96.7 


0.8 


1800 


Potatoes 1 


10.0 


68.0 


22.0 


1.8 


0.2 


19.1 


0.9 


395 


Potatoes 




75.5 


24.5 


2.0 


0.2 


21.3 


1.0 


440 


Sweet potatoes .... 




75.8 


24.2 


1.5 


0.4 


21.1 


1.2 


435 


Turnips 




91.2 


8.8 


1.0 


0.2 


6.9 


0.7 


155 


Carrots 




87.9 


12.1 


1.0 


0.2 


10.1. 


0.8 


215 


Cabbage 




90.0 


10.0 


1.9 


0.2 


6.2 


1.2 


170 


Melons 




95.2 


4.8 


1.1 


0.6 


2.5 


0.6 


90 


Apples 




84.8 


15.2 


0.4 




14.3 


0.5 


275 


Pears 




83.0 


17.0 


0.4 




16.3 


0.3 


310 


Bananas 




73.1 


26.9 


1.9 


0.6 
Alco- 


23.3 


1.1 


495 


Beverages : 










hol. 








Lager beer 




90.3 




0.4 


2.0 


5.8 


0.2 




Porter and ale ... . 




88.1 




0.6 


5.1 


6.8 


0.4 




Rhine wine, white . . 




86.3 






9.3 


2.3 


0.2 




Rhine wine, red . . . 




86.9 






8.1 


3.0 


0.3 




French wine, claret 




88.3 






8.0 


2.3 


0.2 




Sherry wine 


1 • • 


79.5 






17.0 


3.3 


0.3 





3. It must be easily swallowed. 

4. It must be as attractive to the sight, smell, and taste as possible. 
When milk is given for any length of time its taste should be varied, 

if possible, by the addition of enough coffee, tea, cocoa, or sweetening 
to prevent the patient from taking a dislike to it. Its nutritive prop- 
erties may often be advantageously increased by the addition of some 



1 As purchased, including refuse, skin, etc. 

35 



546 FEEDING THE SICK. 

of the well-known infant foods; and if it curdles too quickly in the 
stomach, this may be delayed by the use of barley-water in equal 
parts, or lime-water, or by the addition of thin oatmeal gruel or strained 
rice to the milk. Often the addition of salt improves the taste and 
aids its digestion, and its dilution by adding aerated or carbonated 
water from a siphon is also refreshing and aids digestion in some 
instances. In other instances the best results are produced by pep- 
tonizing the milk (see below). When broths are used, they may 
well be flavored with other things than the meat from which they 
are made. This is easily accomplished by placing in a small bag 
such vegetables as carrot, turnip, celery, parsnip, parsley, thyme, 
etc., and then cooking this bag and its contents with the broth, whereby 
the nutritive properties of the meat and vegetables and the flavoring 
of the latter are given to the soup. 

The following recipes will be found useful in many cases : 

PEPTONIZED MILK. 

Take a perfectly clean, clear glass quart bottle and place in it one 
of Parke, Davis & Co.'s peptonizing tablets, or the contents of one 
of Fairchild's peptonizing tubes, and a teacupful of cold water, and 
after shaking pour into the bottle a pint of perfectly fresh, cool milk 
and stir the mixture thoroughly. Next place the bottle containing 
the milk in a can of water at such a temperature that the whole hand 
may be submerged in it without pain. If complete digestion of the 
milk is desired, this application of heat may be continued as long 
as twenty minutes, but in most cases five minutes are sufficient. If 
carried on longer than five minutes, the milk will become bitter and dis- 
agreeable to the taste through the development of peptone in excess. 

Immediately after taking the bottle from the hot water it should 
be placed on ice, in order to check further peptonizing and to keep 
the milk from spoiling; or if ice is not available the water-bath 
should be quickly brought to a boil in order to prevent further action 
of the ferment, and the bottle corked and then be put in a cool place. 
This recipe may be used where it is thought necessary to digest the 
milk before it is swallowed. Where we desire simply to aid digestion 
it is best to follow the directions already given, except that the bottle 
is not heated, but at once placed upon ice and allowed to remain 
there, being slightly warmed when it is desired to give it to a child, 
or it may be given as a cool and refreshing drink to an adult, the 
heat of the body rapidly causing the ferment to do its work as soon 
as the food enters the stomach. When irritability of the stomach 
exists in adults, this peptonized milk may be made more agreeable to 
the taste by following the directions given in the first recipe, except 
that it must remain in the hot water for no less than two hours, when 
it is poured out into a tin cup or pan and rapidly brought to the boil- 
ing-point. After this it is strained through a piece of coarse muslin 



PEPTONIZED BEEF. 547 

and placed upon ice. Before giving it to a patient this mixture may 
be flavored with lemon- or orange- juice or any form of acid that is 
desired, without the milk becoming curdled. Peptonized milk-punch 
is made from milk prepared in the way* already described in the first 
recipe by adding. St. Croix or Jamaica rum or brandy, and is a pleas- 
ant nutrient, particularly if the surface of the liquid is sprinkled with 
a little grated nutmeg. 

A very refreshing and agreeable drink may be made by diluting 
peptonized milk one-half with highly charged carbonic-acid water, 
and swallowing it while effervescing. 

PEPTONIZED BEEF. 

The following method of preparing Peptonized Beef is recom- 
mended by the Fairchilds, and is very useful, as is also peptonized 
oyster stew, as first introduced by the late Dr. N. A. Randolph. 

Take \ pound of finely minced raw lean beef; cold water, \ pint. 
Mix in a saucepan. Cook over a gentle fire, stirring constantly until 
it has boiled a few minutes. Then pour off the liquor for future use, 
beat or rub the meat to a paste, and put it into a clean fruit- jar with 
| pint of cold water and the liquor poured from the meat, and add 

Extract! pancreatis 20 grains (1.3). 

Sodii bicarb. 15 " (1.0). 

Shake well together, and set aside in a warm place, at about 110° to 
115° F., for three hours, stirring or shaking occasionally; then boil 
quickly. The liquid may then be strained or clarified with white of 
egg in the usual manner, and seasoned to taste with salt and pepper. 

In the great majority of cases it is not necessary to strain the pep- 
tonized liquor, for the portion of meat remaining undissolved will 
have been so softened and acted upon by the pancreatic extract that 
it will be in very fine particles and diffused in an almost impalpable 
condition, and is therefore in a form ready for assimilation in the 
body. 

Peptonized Oysters. — Peptonized Oysters are prepared by mincing 
six to twelve large oysters, and adding to them, when mixed with a 
moderate amount of their own liquid, 5 grains (0.30) of pancreatin 
or peptonizing powder and 20 grains (1.3) of sodium bicarbonate. 
The cup containing this mixture is now placed in water at 100° F., 
and allowed to remain there from ten to twenty minutes, accord- 
ing to the degree of digestion desired. After this the liquid mass 
is quickly brought to a boil to cook the oysters and stop digestion, 
and served with pepper and salt as required. Any condiment or 
flavoring substance may be used. 

PEPTONIZED ENEMATA. 

A very useful nutrient enema may be prepared by following the 
directions given above for peptonizing milk, except that an egg, yolk 



548 FEEDING THE SICK. 

and white, should be beaten up in the milk before the ferment is 
added. The effect of this enema may be increased by the addition 
of a teaspoonful to an ounce of whiskey or wine. This should be 
warm when injected into the rectum. 

As the rectum is apt to become irritable if injections are given 
frequently, and particularly if the same mixture is repeated a number 
of times, it is often well to substitute for the formula just given the 
following recipes: 

Von Leube recommends 5 ounces of scraped meat, chopped very 
fine, and to this are added 1^ ounces of finely chopped pancreas; 
the whole is suspended in 3 ounces of lukewarm water, and stirred 
to the consistence of a thick pulp. This makes one injection. Pan- 
creatin or peptonizing tablets can be as well used as the pancreas 
itself. 

Mayet uses 150 to 200 grammes of pancreas bruised in a mortar 
with water at a temperature of 100° F., and then strained through 
a cloth; 400 to 500 grammes of lean meat are chopped fine and the 
strained pancreatic fluid mixed with the mince, together with the 
yolk of 1 egg. This is allowed to stand for two hours, and should be 
administered at the body temperature: the quantity is sufficient for 
twenty-four hours' nourishment, and should be administered in two 
parts. 

Rennie's formula consists of \ pound of lean meat pulled into 
shreds and added to a pint of beef-tea; to this are added 1 drachm 
of fresh pepsin and \ drachm of dilute hydrochloric acid; the mix- 
ture is kept at a temperature of 99° F. for four hours, during which it 
is stirred constantly. If too great heat be employed, the digestive 
process will stop. 

An enema which Bidwell employs is made as follows: milk, 2 
ounces; strong beef-tea, 2 ounces; yolk of egg, 1; pancreatic solution, 
1 drachm. This is to be prepared one hour before use, and to be 
kept at a temperature of 100° F.; h to 1 ounce of brandy is added, 
when necessary, immediately before use. 

Greig Smith uses 1 egg beaten up in 6 ounces of milk with 2 or 3 
teaspoonfuls of meat- jelly, or peptones may be added. This is admin- 
istered warm with or without \ an ounce of brandy every five or six 
hours. 

DIGESTED GRUEL. 

Digested gruel may be made by taking thoroughly boiled hot 
gruel made from oatmeal, barley, wheat, or from arrowroot, to the 
amount of \ pint (240 c.c), and adding thereto, while it is hot, \ pint 
(240 c.c.) of fresh, cold milk; to this may now be added the contents 
of one peptonizing tablet or tube, and the mixture allowed to stand in 
moderately hot water or in a warm place for twenty minutes before it is 
placed upon ice. 



DIET LIST. 549 



KOUMYSS. 



This is a preparation of milk which is very useful for children and 
adults during convalescence from acute or subacute exhausting dis- 
eases. Even children of three or four years will acquire a liking for it 
if it is not made too sour by continuing the fermentation process 
too long. The liquid is prepared as follows: Add to 1 pint (480 c.c.) 
of cool, perfectly fresh milk 2 teaspoonfuls (8.0) of sugar, and place 
it, after shaking thoroughly, in a clean beer or claret bottle. Then add 
J of a cake of Fleischman's compressed Vienna yeast, and tightly cork 
the bottle, standing it in a warm place or in a water-bath at 99° to 
100° F. for eight to ten hours. Then place in a cool place or on ice 
and use as needed. It must be remembered that the development of 
carbonic gas is very great in this liquid, and that if an ordinary cork 
is inserted it must be tied in before the heat is applied. Further 
than this, the cork must be pulled very gently or the liquid will spurt 
all over the room. The best thing to use when about to open a bottle 
of koumyss is a " champagne tap," by means of which the liquid may 
be drawn off as needed. 

DIET LIST. 

The following bills of fare are used in the Children's Hospital in 
Philadelphia with good results, are easily prepared, and the directions 
readily carried out by the inexperienced. 

Diet in Gastrointestinal Catarrh for a Child of Seven Years. 

Breakfast, 7.30 a.m.: Milk, with lime-water; 4 teaspoonfuls of 
lime-water to each tumblerful of milk. The lightly boiled yolks of 
two eggs, thin slices of well-toasted bread, or stale bread. 

Dinner, 12 m. : A mutton-chop without fat, broiled; or a slice of 
roast beef or mutton ; occasionally a bowl of meat broth. Stale bread 
or toast. 

Supper, 7 p.m.: Milk and lime-water. Stale bread or toast, or 
milk toast. 

For drink: Filtered or boiled water. 

Starch foods to be avoided as much as possible. 

Diet for a Child Two Years Old. 

Breakfast, 7.30 a.m.: Milk. The lightly boiled yolk of an egg. 
Thin bread and butter (the bread to be one day old). 

Lunch, 11 a.m.: Milk. A thin slice of bread and butter. 

Dinner, 1.30 p.m.: Beef- tea or small piece of minced roast beef or 
mutton devoid of gristle. One well-mashed potato, moistened with 
gravy. Rice and milk. 

Supper, 6 p.m.: Milk. Bread and butter. 

For drink: Boiled or filtered water. 



550 FEEDING THE SICK. 

Diet for a Child One Year Old (5 meals a day). 

First meal, 7 a.m.: 2 teaspoonfuls of grated flour-ball (prepared 
as directed below) in J pint of milk. 

Second meal, 10.30 a.m. : \ pint of milk with 4 tablespoonfuls of 
lime-water. 

Third meal, 2 p.m. : The yolk of 1 egg beaten up in 1 teacupful of 
milk. 

Fourth meal, 5.30 p.m.: Same as the first. 

Fifth meal, 11 p.m.: Same as the second. 

Flour-ball is to be made by taking one pound of good flour — unbolted 
if possible — tie it up very tightly in a pudding-bag; put it in a pot of 
boiling water early in the morning, and let it boil until bedtime, then 
take it out and let it dry. In the morning peel off the surface and 
throw away the thin rind of dough, and with a grater grate down the 
hard, dry mass into a powder. To use this, take from 1 to 2 teaspoon- 
fuls of the powder, rub it down until smooth with a tablespoonf ul of cold 
milk, and add 1 tumblerful of hot milk, stirring it well all the time. 

Diet for a Child from Six to Twelve Months Old (5 meals a day). 

First meal, 7 a.m. : Mellin's food 1 tablespoonful or flour-ball grated 
1 or 2 teaspoonfuls (prepared as directed above) ; hot water 4 table- 
spoonfuls; warm milk, enough to make J pint. Dissolve the Mellin's 
food or rub down the grated flour-ball in the hot water by stirring, 
then add the milk; mix thoroughly. 

Second meal, 10.30 a.m., and third meal, 2 p.m.: A breakfastcupful 
of milk with 4 tablespoonfuls of lime-water. 

Fourth meal, 5.30 p.m.: Same as first. 

Fifth meal, 10.30 p.m.: Same as second. 

BEEF-TEA. 

Take 1 pound of lean beef and mince it. Put it with its juice into 
an earthen vessel containing a pint of tepid water, and let the whole 
stand for one hour; strain well, squeezing all the juice from the meat. 
Place on a fire, and slowly raise just to the boiling-point, stirring 
briskly all the time. Season with salt and pepper to taste. In admin- 
istering this always be careful to stir up the sediment. 

Or, take 2 pounds of beef without fat or bone, and half a breakfast- 
cupful of cold water; place in a jar in a saucepan of water; simmer 
four hours. 

RESTORATIVE BEEF ESSENCE (Ringer). 

Take 1 pound of fresh beef free from fat, chop it fine, and pour 
over it 8 ounces of soft water, add 5 or 6 drops of hydrochloric acid 
and 50 or 60 grains of common salt; stir it well, and leave for three 
hours in a cool place. Then pass the fluid through a hair sieve, press- 



WINE-WHEY. 551 

ing the meat slightly, and adding gradually toward the end of the 
straining about 2 ounces more of water. The liquid thus obtained is 
of a red color, and possesses the taste of soup. It should be taken cold, 
a teacupful at a time. If preferred warm, it must not be put on the 
fire, but heated in a covered vessel placed in hot water. 

Should it be undesirable for the patient to take the acid, this soup 
may be made by merely soaking the minced beef in distilled water. 
Or, take 1 pound of beef free from fat and skin, chop it very 
fine, add a little salt, and put it into an earthen jar with a lid, such 
as is used for roasting venison; seal the edges with a thick paste, 
and place the jar in an oven for three or four hours; strain through 
a coarse sieve. Give the patient two or three teaspoonfuls at a time. 
Or, cut in small pieces 1 pound of lean beef from the sirloin or rump, 
and place it in a covered saucepan, with J pint of cold water, by 
the side of a fire for four or five hours ; then allow it to simmer gently 
for two hours, skim well, and serve. 

BARLEY-WATER. 

To prepare barley-water, put 2 good-sized teaspoonfuls of washed 
pearl barley with 1 pint of cold water in a saucepan, and boil slowly 
down to two-thirds. Strain. 

Barley-water for Adults. 

Take of finest barley J pound; to this add 1 quart of water and boil 
to 1 pint; strain and add 1 quart of boiled milk. To this add 6 ounces 
each of brandy and lime-water; sweeten to taste; flavor with nutmeg 
and rind of lemon rubbed with sugar. This forms a most nourishing 
and palatable drink when kept cold on ice. 

OATMEAL-WATER. 

Add 1 tablespoonful of oatmeal-flour to 1 pint of water and boil 
down to two-thirds of a pint. Strain. To this may be added, as 
additional nourishment, beaten white of egg. 

RICE-WATER. 

Rice-water is made by boiling 2 ounces of clean rice in 2 quarts of 
water for an hour and a half. 

WINE-WHEY. 

Boil 1 pint of fresh milk; while boiling pour in 1 small tumblerful 
of sherry wine (8 tablespoonfuls) ; bring to the boil a second time, 
being careful not to stir it; as soon as it boils set it aside until the curd 
settles, and pour off the clear whey. 



552 FEEDING THE SICK. 

ALMOND BREAD FOR DIABETICS. 

Take of blanched sweet almonds \ pound; beat them as fine as 
possible in a stone mortar; remove the sugar contained in this meal 
by putting it into a linen bag and steeping it for a quarter of an hour 
in boiling water acidulated with vinegar; mix this paste thoroughly 
with 3 ounces of butter and 2 eggs. Next add the yolks of 3 eggs and 
a little salt, and stir well for some time. Whip up the whites of 3 eggs 
and stir in. Put the dough thus obtained into greased moulds, and 
dry by a slow fire. 

BRAN BREAD FOR DIABETICS. 

Take a sufficient quantity (say 1 quart) of wheat-bran; boil it in 
two successive waters for a quarter of an hour, each time straining it 
through a sieve; then wash it well with cold water (on the sieve) until 
the water runs off perfectly clear; squeeze the bran in a cloth as dry 
as possible, then spread it thinly on a dish and place it in a slow oven; 
if put in at night, let it remain until morning, when, if perfectly dry 
and crisp, it will be fit for grinding. The bran thus prepared must 
be ground in a fine mill and sifted through a wire sieve of such fineness 
as to require the use of a brush to pass it through; that which remains 
in the sieve must be ground again until it becomes quite soft, and fine. 
Take of this bran powder 3 ounces (some patients use 4 ounces), the 
other ingredients as follows: 3 new-laid eggs, 1J ounces (or 2 ounces 
if desired) of butter, and about \ pint of milk; mix the eggs with a 
little of the milk, and warm the butter with the other portion; then 
stir the whole well together, adding a little nutmeg or ginger or any 
other agreeable spice. Bake in small tins (patty-pans), which must 
be well buttered, in a rather quick oven for about half an hour. The 
cakes, when baked, should be a little thicker than ship biscuit; 
they may be eaten with meat or cheese at breakfast, dinner, and supper; 
at tea they require rather a free allowance of butter, or they may be 
eaten with curd or any of the soft cheeses. 

"It is important that the above directions as to washing and drying 
the bran should be exactly followed, in order that it may be freed 
from starch and rendered more friable. The bran in its common state 
is soft, and not easily reduced to fine powder. In some seasons of 
the year, or if the cake has not been well prepared, it changes more 
rapidly than is convenient, owing to moisture. This may be prevented 
by placing the cake before a fire for five or ten minutes every day." 

ALMOND MILK. 

Add 1 to 2 ounces of scalded sweet almonds, deprived of their skins, 
to a little hot water and thoroughly rub them into a pulp, adding 
nearly a pint of scalding water while rubbing. Then boil for fifteen 



JUNKET. 553 

minutes; strain, and add enough water to make a pint. This may be 
sweetened with sugar if desired, and is excellent for children that 
cannot take milk. 

ARTIFICIAL MILK FOR DIABETICS. 

Williamson has given the following recipe: "To about a pint of 
water placed in a large drinking-pot or tall vessel, about two or three 
tablespoonfuls of fresh cream are added and well mixed. The mixture 
is allowed to stand for twelve or twenty-four hours, when most of the 
fatty matter of the cream floats to the top; it can be skimmed off with 
a teaspoon easily, and on examination it will be found practically free 
from sugar. The milk-sugar remains dissolved in the water. This 
fatty matter thus separated is placed in a glass and mixed with water. 
Then the white of an egg is added and the mixture well stirred. The 
water and white of the egg are added in sufficient quantities to make a 
mixture which has the exact color and consistence of ordinary milk. 
If a little salt and a trace of saccharin be added, a palatable drink is 
obtained which has almost the same taste as milk, and which contains 
a large amount of fatty material and is practically free from milk- 
sugar. With very little practice the right proportions can be easily 
guessed, and, of course, much larger quantities than those mentioned 
can be prepared." 

MULLED WINE. 

Boil some spices — cloves, nutmeg, cinnamon, or mace — in a little 
water, and add as much of this decoction as is necessary to flavor a 
wineglassful of sherry or any other wine. Add sugar to taste, and 
bring the mixture to the boiling-point. If claret is used, it will require 
more sugar than if a less sour wine is employed. The vessel for heating 
the wine should be scrupulously clean. 



WATERED TOAST. 

Brown several pieces of bread, and carefully butter the toast so that 
the butter is equally distributed. Place enough salt over the toast to 
flavor it and add pepper to taste. Finally pour as much boiling water 
on the edges of the crust as is necessary to soak them thoroughly, and 
serve. This is a more agreeable dish than would be imagined, and 
is useful where milk toast is distasteful. 

JUNKET. 

Add from \ to 1 teaspoonful of Parke, Davis & Co.'s pepsin cordial 
or Fairchild's essence of pepsin to a pint of milk, which should be at 
body-heat. Place the milk in a cool place, and after the curd has 
formed serve cold and flavor with powdered nutmeg or vanilla. If 



554 FEEDING THE SICK. 

there be too great feebleness of digestion to digest the curd, the liquid 
whey may be given, as it contains the salts and soluble albuminoids 
of the milk. 

Junket may be considerably increased in nutritive value if to the 
milk before it is warmed is added an egg which has been thoroughly 
beaten. In place of the egg a tablespoonful of cocoa may be added 
to 2 teaspoonfuls of sugar and rubbed into a paste with a little water. 
This is added to the warm milk, and then the pepsin is added to 
make the junket. 



PART IV 

DISEASES. 



ABORTION, 



The treatment of abortion divides itself into three parts: the first 
for its prevention, the second for its arrest when threatened, the third 
for its proper care when inevitable. 

In the preventive means we find, as in nearly every branch of 
medicine, that the use of hygienic measures is more important than 
the employment of drugs. If previous abortions are known to be due 
to syphilis, endometritis, or uterine displacements, these conditions 
must be relieved by the proper remedies. If there exists no apparent 
cause for the interruption of normal gestation, the patient should use 
a simple diet, lead a quiet life, avoid all sexual intercourse, sleep on a 
hard bed, and resort only to gentle exercise. Fresh air is, however, 
a necessity, and should be plentifully supplied. The food should be 
light, but nutritious and palatable, and a sufficient variety supplied to 
avoid any repugnance to a given dish. In many cases abortion is due 
to deficient nutrition of the foetus, either by reason of faulty assimila- 
tion on the part of the mother or because of poor food, so that if anaemia, 
debility, or other impoverished states of the maternal system be present, 
these should be treated at once. The clothing should be loose, the 
night's sleep undisturbed and of full length, and the mind be set at 
rest as far as possible in respect to household and other worries, and 
particularly diverted from the thought of possible uterine disturbance. 

The use of drugs is to be limited strictly to the fulfilment of a dis- 
tinct indication, and the employment of cathartics is to be avoided, 
the bowels being kept in order by fresh fruits in moderate quantity 
or by mild laxatives, such as cascara sagrada in small doses and com- 
pound liquorice powder. If these fail, rhubarb may be resorted to, 
and castor oil in capsule may be used. Podophyllin, senna in full 
doses, saline purges in active amounts, and aloes are not to be used 
if they can be avoided. If the woman be exceedingly stout and ple- 
thoric, saline purges are indicated to act as depletants. It is hardly 
necessary to add that elaterium and scammony or jalap are not safe, 
and can only be used if dropsy and ascites are present, and where we 
must choose the least of two evils. Strychnine, which stimulates the 

(555) 



556 DISEASES. 

spinal cord, should never be employed, and cantharides, oil of erigeron, 
and manganese ought not to be used unless they are for some reason 
very necessary. Although quinine is not of itself an abortifacient, it 
is unsafe in very large doses if an abortive tendency is present, and can 
only be used as a prophylactic in cases in which abortion is brought 
about by malarial infection. 

The only drug which seems to be of any service as a prophylactic 
to be taken all through pregnancy is the fluid extract of viburnum 
prunifolium, the dose of which is J to 1 drachm (2.0-4.0). This drug 
is said to be a uterine sedative and to have no injurious effect upon the 
mother or child. 

The arrest of threatened abortion is one of the most difficult duties 
which come to the physician, and there is no doubt that large 
doses of morphine or opium are the best means of quieting the 
uterus. While viburnum prunifolium may be resorted to, we do not 
know enough of it to rest assured of its value, but it should be tried 
if opium is not at hand or fails. The patient should be at once 
placed in bed in the most comfortable position, be so covered as to 
prevent overheating or taking cold, and receive by the hypodermic 
needle \ grain (0.015) of morphine, or, better still, a rectal injection 
of warm starch-water containing 45 minims (3.0) of laudanum. The 
bulk of the injection should be small in order not to disturb the bowels, 
and must be at the body temperature. If this is not done, a suppository 
of the aqueous extract of opium, containing J to \ grain (0.015-0.03), 
should be used. Ice-cold drinks should be given, and no tea or coffee 
allowed. This treatment quiets the uterus, allays nervousness and 
restlessness, and at least puts off the abortion for a few hours. Vene- 
section has been practised in very plethoric women with advantage. 

When an abortion is inevitable, it is to be treated by measures directed 
to the avoidance of hemorrhage, the thorough delivery of the ovum 
and its appendages, and the prevention of inflammation and septi- 
caemia. The latter accident is to be prevented by the most rigid asepsis 
of the patient and physician. For the prevention of hemorrhage a 
number of balls of aseptic absorbent cotton tightly wound with thread 
to the size of a small egg should be packed into the vagina back of 
and around the cervix until the bleeding is controlled, and, while a 
small amount of iodoform may be dusted over them before they are 
inserted, no astringents are to be applied, unless it be tannic acid to 
coagulate the blood in the cotton, as astringents cannot reach the 
bleeding spot. Sponges ought never to be used, as they often fail to 
control the bleeding and rapidly become septic. By means of this 
packing the blood in the uterus cannot escape, and as the uterine walls 
contract they urge the liquid between the membranes, thereby causing 
complete separation. After the tampons are applied ergot should be 
used in the dose of a fluidrachm of the extract or a tablespoonful 
or two of the wine, unless the uterine contractions are already active. 
Generally after twenty-four hours the removal of the tampons will 



ABSCESS. 557 

show the ovum to be in the vagina, but if part of it remains in the uterus, 
the following measures should be resorted to: The administration of 
ergot should be stopped unless the hemorrhage is severe, and the 
uterine cavity is to be cleared by the use of the fingers of the attendant, 
who grasps the membranes and draws them away. In skilful hands 
the curette may be employed. If the cervical canal is too small, it 
must be dilated by dilators. After the membranes are removed the 
tincture of iodine may be applied to the inner surface of the uterus as 
a haemostatic, antiseptic, and alterative; or, better still, the uterus 
should be douched with a 2 per cent, solution of creolin in warm water, 
about a quart being used at a low hydrostatic pressure. A pumping 
syringe should not be used. 

The after-treatment consists in the use of small doses of ergot and 
quinine, of vaginal antiseptic irrigation, or even of uterine irrigation 
if it is needed, and the maintenance of perfect rest for one or two 
weeks, or longer if possible. Ergot ought not to be given if there is 
reason to believe that portions of the membranes or blood-clots are in 
the uterus, as by contraction of the os uteri it may imprison materials 
which then become septic. (See Puerperal Diseases.) If fever arise, 
the uterus should be carefully curetted and the intra-uterine douches 
of creolin continued until the fever disappears. 

ABSCESS. 

The medical treatment of abscess resolves itself into the use of drugs 
to prevent the further formation of pus, to cause its fatty degeneration 
and absorption, to quiet the systemic disturbance if inflammation be 
severe, and to support the body if the suppuration be prolonged or in 
large amount or if debility exists. The treatment may also be divided 
into that suited to acute and that to chronic abscess. 

As acute abscess in its early stages is simply a localized inflamma- 
tion with hyperemia and an outpouring of leukocytes, it may often 
be modified by the use of aconite or veratrum viride in full dose to 
quiet the circulatory excitement and relieve the congestion. This is 
particularly true where the pain is pulsating. At the same time, if 
the swelling is superficial, a poultice, made by moistening bread- 
crumbs with lead-water, should be placed over it, or lead-water may 
be placed on lint and applied in this way. Belladonna ointment 
smeared over the same area may be of service, and the tincture may 
be used internally if aconite cannot be used. If a gland be involved, 
the needle of a hypodermic syringe may be inserted obliquely into 
its centre and 5 to 10 minims (0.3-0.60) of a 2 per cent, solution of 
phenol injected into the swelling. This method has been found of 
singular efficacy in bubo when pus seems just about to form. It 
is very often curative, but should not be used in a stronger or weaker 
solution than that named. Another useful abortive method for the 
treatment of the early stages of abscess is the application, externally, 



558 DISEASES. 

of a strong solution of nitrate of silver, 20 to 40 grains to 1 ounce 
(1.3-2.6:30.0) of water, by means of a camel's-hair brush, all over 
the skin covering the area involved, or by the use of the tincture of 
iodine in a similar manner. 

Internally, calx sulphurata, in the dose of y^- grain (0.006) given 
every hour or two, may be used as an abortive, or at least to promote 
arrest and cause absorption. If it becomes evident that pus is going 
to form, then resort must be had to poultices, which by their heat and 
moisture will aid in the formation of pus by favoring the escape of 
leukocytes and by softening the tissues. The best form of poultice for 
this purpose is to use lint which has been saturated with a 1 : 4000 
solution of mercuric chloride, the moisture being retained by a piece of 
rubber dam placed over the lint. If pus forms and fluctuation ensues, 
the abscess should be freely opened, drained, washed out by a solu- 
tion of carbolic acid in the strength of 1 : 20, or of bichloride solution 
1 : 5000, and dressed with antiseptic gauze. If it is tubercular, the 
abscess may be opened in the ordinary manner, all diseased tissues 
removed by scraping, and the cavity packed with iodoform gauze, or if 
it cannot be drained in this way it should be drained by aspiration, 
and an ethereal solution of iodoform injected and allowed to remain 
in the abscess-cavity if it is a small one. The opening is now closed 
by a pledget of cotton wet with tincture of benzoin, and an antiseptic 
dressing applied over it. Not more than 20 grains (1.3) of iodoform 
should be so used in the treatment of tubercular abscess, as larger 
amounts have caused poisoning. 

A very good treatment for slow abscess is to wash out the cavity 
with a 10- volume solution of peroxide of hydrogen, provided there is 
a free exit for the gas which is given off. 

If the abscess is chronic (cold abscess) and associated with great 
weakness, resort must be had to the internal use of iron in the form 
of the tincture of the chloride, cod-liver oil with hypophosphites, 
quinine as a tonic to prevent hectic fever, and the use of nutritious, 
easily digested food. Alcohol may be used, and should be given with 
milk or in egg-nog. 

The following tonic pill or solution is of service: 

1$ — Strychninae sulph. gr. j (0.06). 

Ferri redact. . . . . . . . . gr. xv (1.0). 

Quininae sulph gr. xx (1.3). — M. 

Ft. in pil. No. xx. 

S. — One t.i. d. after meals. 



Or, 



1$ — Tr. cinchonse comp., 
Tr. gentian, comp., 

Tr. cardamom, comp aa f §iij (90.0). — M. 

S. — Dessertspoonful (8.0) t.i.d. after meals. 



Having described the means of treatment, it is to be explained 
how these measures act. The aconite quiets the circulation and 
thereby relieves the inflammation, the lead-water acts locally as an 



ACNE. 559 

astringent and sedative, while the belladonna by its action on the 
bloodvessels contracts the dilated capillaries and allays pain. When 
phenol is injected into an enlarged gland, it acts as an anaes- 
thetic, as an antiseptic, and as an astringent and stimulant. The 
nitrate of silver applications act by constringing the bloodvessels, as 
local sedatives, and as counterirritants. The iodine applications do 
likewise, and also exercise an alterative influence. The physiological 
action of calx sulphurata is unknown. The object in using the anti- 
septic irrigations is self-evident, and the employment of iodoform in 
tubercular abscess rests upon the studies of Bruns, of Tubingen, and 
many others, who have found by experiment that the use of iodoform 
is fatal to the bacillus tuberculosis. As large numbers of corpuscles 
are destroyed in the formation of pus, and other sources of vitality 
are sapped by its formation, the use of hypophosphites and iron to 
replace the loss is necessary, and of cod-liver oil and tonics to 
increase the blood-corpuscles and the ability to assimilate food. 

ACNE. 

This affection occurs in so many forms and arises from such dif- 
ferent causes that a thorough consideration of its treatment cannot be 
here given: suffice it to state that arsenic is a remedy which will often 
aid in the cure and prevent a relapse if used in small doses for a long 
period; that is, 1 to 3 minims (0.05-0.20) of Fowler's solution three 
times a day for a month or two. This is particularly useful if debility 
and anaemia underlie the disease. If the anaemia be marked, the 
proper treatment is that directed to the cure of this condition (see 
Anaemia); if obstinate constipation is present, relief must be obtained 
by saline purges and the bowels kept in order by cascara sagrada or 
some similar drug. If scrofulosis exists, cod-liver oil is of great 
service; or if much pustulation is present, calx sulphurata, in the 
dose of -3^ to J grain (0.006-0.008), may be used in pill form three 
times a day. In menstrual acne sulphur may be used internally, in 
the form of the confection of sulphur of the British Pharmacopoeia, 
to open the bowels, and applied as a wash to the face in the following 
form : 

fy— Sulphuris 3J (4.0). 

Glycerini f|j (30.0). 

Aquse rosse q. s. ad fgviij (240.0). — M. 

S. — Apply twice or thrice a day. 

Or the following may be used in cases of severe inflamed acne: 

1$ — Sulphuris iodidi gr. xxx (2.0). 

Cerati simplicis . . . . .^ . . §j (30.0).— M. 
S. — Apply to the parts night and morning. 

If the skin is very atonic, muddy, and torpid, it should be bathed 
night and morning with hot water and castile soap, or even with the 
tincture of green soap, and well rubbed with a wet towel. After this 
the following salve may be thoroughly applied: 



560 DISEASES. 

fy — Sulphur, prsecip 5ss (2.0). 

Lanolin., 

Adipis aa §ss (16.0). — M. 

S. — Apply as directed. 

If the green soap causes irritation, some bland application should 
follow it, such as simple cerate or the emulsion of the oil of sweet 
almonds. If the pustules be large, they may be incised and vent 
given to their contents, the sac being touched with a drop of carbolic 
acid. If induration is great, ichthyol ointment of the strength of 20 
parts of ichthyol to 100 of lard should be well rubbed in, or resorcin, 
10 to 20 grains to the ounce of lard (0.60-1.3 : 30.0), be applied. Mer- 
curial ointment may also be used to lessen induration, but several 
days should elapse between its use and that of sulphur, as otherwise 
a black sulphuret of mercury will be formed and stain the skin. 

The diet should be carefully regulated and fatty foods avoided. 

ADENITIS. 

Cervical adenitis is an inflammation of the lymphatic glands, usually 
due to tuberculosis unless there be some specific infection, such as 
syphilis, present. Occasionally it may arise from other forms of infec- 
tion in the mouth or tonsils. 

If the condition is a simple enlargement, it should be treated by 
inunctions of iodine ointment and lard, half-and-half, night and morn- 
ing, care being taken that the use of the ointment is stopped as soon 
as reddening of the skin appears or if fluctuation develops. If for any 
reason the ointment cannot be used, the tincture of iodine should be 
thoroughly painted over the swelling, but this treatment is less effica- 
cious. The following is a useful application: 

fy— Ichthyol. . m 3iy (16.0). 

Adipis benzoinat S i j (60.0). — M. 

. S. — Rub a small piece of the ointment into the swelling t.i.d. 

Syrup of the iodide of iron, in the dose of 5 to 20 drops (0.30-1.3), 
may be given, and tonics should be used to improve the systemic 
condition. As soon as fluctuation or reddening shows the forma- 
tion of pus, all abortive treatment should be stopped, and a poultice 
be applied for twenty-four or forty-eight hours till the swelling is 
ready for lancing. Lancing is better than allowing the abscess to 
break, as the scar left in after years is a mere line instead of a large 
cicatrix. 

If the pus is found to be tuberculous or if the swelling persists — and 
a large number of these cases are so infected — the following treatment, 
recommended by Treves and Griinfeld, is of value and should be 
insisted upon: 

The entire removal of the glands should be effected by dissection 
alone; directors, handles of scalpels, or fingers should be used to 
separate the glands from the surrounding cellular tissue as closely 



AMBLYOPIA AND AMAUROSIS. 561 

from the capsule as a nerve is cleaned in the dissecting-room. When 
sufficient amount of the anterior surface is exposed, a thick thread is 
passed through the gland and drawn gently, when, by continuing the 
dissection, the operator may gradually get to the back of the gland, 
removing portions of the mass at a time. The cavity should be 
packed with iodoform gauze, and the walls scraped if an abscess has 
existed. 

ALCOHOLISM. 

(See Alcohol.) 

ALOPECIA. 

This affection, when due to a parasite, is best treated, according to 
Crocker, by first pulling out all the loose hairs around the bald spot 
and then painting the affected surface with linimentum cantharidis 
(liquor epispasticus) . Three coats of this liquid should be employed, 
and each coat allowed to dry before the next is applied. In other cases 
an ointment of chrysarobin, J to 1 drachm (2.0-4.0) to the ounce 
(30.0) of lanolin, may be used, but care must be exercised that too 
much staining of the skin and clothes does not result. Another equally 
good application is 2 grains (0.12) of mercury bichloride to 1 drachm 
(4.0) of rectified spirit and 7 drachms (28.0) of oil of turpentine. This 
mixture may be rubbed in with the finger over and around the patch. 
If the patient's skin will stand it, 5 grains (0.3) of the corrosive sub- 
limate may be used in place of 2 grains (0.12). 

AMBLYOPIA AND AMAUROSIS. 

Amblyopia (or dulled vision) and amaurosis (or blindness) usually 
refer to defective sight or its total loss, the result of functional dis- 
turbance of the retina, optic nerve, or visual centres, and unaccom- 
panied by changes in the eye-grounds in the beginning of the disease. 
These terms, however, also include cases of partial or complete blind- 
ness in which optic-nerve atrophy subsequently develops, and are often 
used to describe ocular disorders not limited by the definitions here 
employed. These cases may be gathered into certain groups: 

I. Congenital amblyopias and amblyopias from non-use of the 
eye. In these there is often a high degree of error of refraction, 
usually far-sightedness; the latter is seen when an eye is debarred 
from binocular vision by a squint. In both the treatment consists in 
as perfect a correction of the optical error as possible, and, in case 
one eye alone is involved, the separate exercise of its functions. Con- 
genital amblyopias may include incurable defects in the structure of 
an eye. 

II. Amblyopias the result of (a) general diseases or conditions — 
typhoid fever, the exanthemata, syphilis, scurvy, malaria, colds, etc.; 
(b) local diseases or conditions — hemorrhoids, hemorrhage, pregnancy, 

36 



562 DISEASES. 

disordered menstruation, kidney disease, diabetes, migraine, disorders 
of the nervous system, etc. 

The remedies indicated by the special cause are to be employed, 
the medicinal agents most usually needed being mercury, iodide of 
potassium, pilocarpine, particularly in uraemic amaurosis, emmena- 
gogues, and tonics, especially hypodermics of strychnine. As local 
measures repeated fly-blisters to the temples, wet and dry cups, and 
the constant electric current are used. The nape of the neck may be 
cauterized. In hysterical cases metallotherapy may be tried. 

III. Amblyopias the result of the action of certain medicinal and 
toxic agents. 

The abuse of alcohol, and particularly of tobacco, produces a form 
of amblyopia characterized by the development of a scotoma or an 
area in the centre of the field of vision in which the appreciation of 
red and green is lost or greatly diminished. Quinine in excess has, 
in a number of instances, been followed by temporary blindness, 
which is usually denominated quinine amaurosis. Methyl alcohol 
by itself or in the form of adulterated essence of ginger or bay rum, 
even in comparatively small quantities, may produce rapid blindness 
and atrophy of the optic nerve. Of less frequent occurrence are the 
cases of amblyopia produced by the toxic action of salicylic acid, lead, 
silver, mercury, osmic acid, nitrobenzol, filix mas, thyroid extract, and 
the vapor of bisulphide of carbon. In all instances the patient must 
be withdrawn from the influence of the poison; in tobacco amblyopia, 
in its early stages, this is usually sufficient to effect a cure. The rem- 
edies which have proved of the greatest utility are digitalis, inhalations 
of nitrite of amyl, nitroglycerin, and strychnine. Iodide of potassium 
should be exhibited in chronic cases, and always in amblyopias the 
result of lead-poisoning. The constant current has also been employed. 

IV. Amblyopias the result of direct or indirect injury or from reflex 
irritations. 

Traumatic amblyopias may follow a blow upon the eye itself or an 
injury of the skull or spinal cord. To carious teeth, intestinal irrita- 
tions, and the presence of parasites a certain number of amblyopias 
have been attributed, but while it is not possible to disprove the asso- 
ciation, such cases must be received with doubt. After the removal 
of the cause strychnine should be exhibited. 

Optic neuritis most frequently depends upon diseases of the 
brain (tumor, abscess) or inflammation of its membrane (meningitis). 
It is also a symptom of numerous disorders — suppression of the menses, 
exposure to cold, rheumatism, anaemia, syphilis, uraemia, lead-poison- 
ing, etc. The remedies are those naturally suggested by the disease 
or condition which has called it into existence. The prognosis depends 
upon the cause. Mercury, iodide and bromide of potassium, the sali- 
cylates, pilocarpine, local bloodletting, and fly-blisters are the remedies 
commonly employed. 

Optic-nerve atrophy is either primary or secondary to disease of 



AMENORRHEA. 563 

the brain or spinal cord or consecutive to an antecedent neuritis. 
After all irritation has subsided the greatest improvement may be 
expected from hypodermic injections * 1 of strychnine, which should be 
pushed to the point of tolerance. Temporary improvement follows 
the inhalation of nitrite of amyl, and, in the hope of improving the 
circulation in the optic nerve, nitroglycerin, digitalis, and similar 
cardiac tonics may be employed. The constant electric current has 
been employed with benefit, especially by voltaic alternations, which 
are more active than simple closures. The following remedial agents 
have also been employed: suspension, stretching the optic nerve, 
Sequardian injections, nitrate of silver, lactate of zinc, phosphorus, and, 
quite recently, hypodermics of antipyrin. Mercury may be used with 
benefit in early stages of the degenerative process, but is of doubtful 
value in advanced cases. It may be administered in the usual manner 
or by subconjunctival injection in the dose of -£§ mg. Suspension and 
injections of testicular juice have little or nothing to commend them. 
Experience has shown that the arrays have no influence in restoring 
vision after atrophy of the optic nerve is established. Sufficient time 
has not elapsed to prove the value of radium and other radio-active 
substances under these circumstances. 

AMENORRHEA. 

This condition depends upon so many causes for its existence that 
it must be treated in many different ways. If ordinary anaemia or chlo- 
rosis shows that there is a deficient supply of blood, measures adapted 
to the relief of such a state are required. (See Anaemia.) In amenor- 
rhcea due to constipation saline purges or other laxatives may be used, 
and the best of these purges is aloes; and, as constipation and anaemia 
are often present simultaneously, a combination of aloes and iron in 
a pill is commonly resorted to. The iron improves the blood, and the 
aloes stimulates and congests the pelvic viscera by bringing blood to 
the sexual organs. Aloes also seems to increase the assimilation of iron 
in some unknown manner. The following pill is often of service, and 
was especially recommended by Goodell: 

1^ — Extract, aloes 5j (4.0). 

Ferri sulphat. exsiccat oij (8.0). 

Asafcetidse . 5iv (16.0). 

Ft. in pil. No. c. 

S. — From one to three pills three times a day at each period. 

Cimicifuga has been highly recommended in chronic and apparently 
causeless amenorrhcea in the dose of 30 minims (2.0) of the fluid 
extract at the time for a proper flow to occur. Within the last few 
years the binoxide of manganese, in the dose of 1 to 3 grains (0.06-0.20), 
has come prominently forward as a remedy in simple idiopathic amen- 
orrhcea, and is undoubtedly of service, but it should be taken for at 
least two weeks before the date upon which each menstruation is 



564 DISEASES. 

expected to occur. Potassium permanganate is also useful during 
the same period, but it is inferior to the binoxide of manganese in 
the author's experience. 

Apiol, the active principle of parsley, may be given in capsules in 
the dose of 3 to 10 minims (0.20-0.60) in the same manner, and the 
oils of rue, savine, and tansy have also been employed in capsule in 
the dose of 5 drops (0.30) three times a jlay. 

In all forms of amenorrhoea a hot sitz-bath at the time for the 
expected "period" is of service, more particularly if the patient has 
"caught cold." The bath should be persevered in for several nights, 
and care should be taken to avoid exposure. Often a little mustard 
added to the water will increase the efficacy of this treatment. 

Under the name of "Dewees's Emmenagogue Mixture," first 
devised by Professor Dewees, of Philadelphia, the following formula 
has been largely used in functional and organic amenorrhoea: 

1^—- Tinct. ferri chloridi f 3iij (12.0). 

Tinct. canthan'dis f5j (4.0). 

Tinct. guaiac. ammon f3jss(6.0). 

Tinct. aloes . . - f gss (16.0). 

Syrupi ....... q. s. ad fgvj (180.0).— M. 

S. — Tablespoonful (16.0) three times a day. 

ANEMIA. 

It is, unfortunately, only too true that the entire subject of blood- 
making and blood-breaking is as yet very imperfectly understood, but 
many of our therapeutic facts rest on rational ground now, if not before, 
and if the pathologists will give us more information upon these sub- 
jects, new remedial measures will be introduced and the empirical 
employment of old ones placed on a rational basis. Practically speak- 
ing, the therapeutist recognizes two very important points, the causes 
of which the pathologist must eventually solve — namely, that one class 
of anaemias are due to defective or deficient haemogenesis, and another 
to excessive haemolysis. The former are generally believed to form 
the simple class, and the latter the essential or pernicious class. It 
is in the excessive hemolysis class that we most frequently fail to pro- 
duce good results. More than this, the causes of excessive haemolysis 
are so various that we can further divide them into removable and 
permanent, the removable being represented by the cases in which 
copraemia or autointoxication takes place, while the others are repre- 
sented by the true pernicious anaemia, about which we know very 
little, save that most observers find evidence of defective haemogenesis 
and of profound haemolysis in the percentage of iron in the liver, while 
in the dark-colored urine they believe a destructive agent exists which, 
prior to its excretion, has slaughtered many corpuscles. Unfortunately, 
f it is at present impossible for us to separate clinically the haemogenous 
anaemia from that of haemolytic excess, unless we find evidence of great 
corpuscular disintegration in a copious elimination of haemoglobin in 



ANjEMIA. 565 

the urine, or a jaundice evidently hematogenous in character, or a large 
number of defective corpuscles, which would perhaps indicate defective 
haemogenesis rather than that they were scarred veterans of a battle 
with a poison in the liver cells or elsewhere. Post-mortem signs often 
aid us in the differential diagnosis, but this is too late to be of any 
benefit to the physician or patient. 

There is one point, however, about which there can scarcely be 
any doubt, and that is that in many cases iron is greatly abused, being 
given when there is no indication for it or more frequently given in 
excessive dose. By excessive dose the author refers to as much as 6 to 
10 grains of reduced iron in a day. The amount of iron in the human 
body is very small, and every study made of its absorption and elimina- 
tion after absorption has shown that these processes are very slow. 
Hamburger recovered from the feces nearly all the iron administered, 
and Jacobi proved that even when the iron was injected into the veins 
10 per cent, was at once eliminated by the bowels, liver, and kidneys, 
and the remainder deposited in the liver, spleen, and other tissues in 
the same manner as is any metallic substance. The researches of 
Gottlieb have also been in confirmatory lines. When we consider 
that there is in the human blood only about 39 grains of iron, all told, 
we can see that the use of 12 grains a day in the course of a little over 
three days places a double quantity of the metal in the economy, 
which is not needed, and is either cast out or deposited at any con- 
venient spot, there to lie undisturbed until it can be extruded. 

Much, of course, depends upon the cause of the anaemia, but there 
is only one excuse for the use of the large doses of iron just named — 
viz., a condition of the digestive apparatus which results in the forma- 
tion of a sulphide of iron in great quantity, so that only an infinitesimal 
amount escapes into the system. This perhaps explains the empirical 
fact that in some cases of chlorosis or intense anaemia iron has to be 
given in large doses to accomplish good results. 

One of the best studies on this subject is that of Ralph Stockman, 
who has given us a masterly summary of the subject of the absorption 
of iron in chlorosis. In this summary he points out that we have 
three chief theories as to the action of iron in anaemia. The first, the 
absorption theory, is based on the fact that as iron is taken into the 
body with the food, the iron of the haemoglobin must be obtained 
from this source, and therefore that medicinal iron given by the mouth 
must be absorbed. The second theory rests upon the belief that 
iron is not absorbed when given by the mouth in addition to that in 
the food, but simply acts as a stimulant to the mucous membrane of 
the alimentary canal, therefore increasing the digestion of food, and 
so overcoming anaemia by the general improvement coincident upon 
proper nutrition. The third theory is that of Bunge — namely, that 
in chlorotic conditions there exists an excess of sulphur or sulphuretted 
hydrogen in the bowel, which changes the iron in the food into a 
sulphide of iron, which Bunge states cannot be absorbed. He believes 



566 DISEASES. 

that the inorganic iron which is given as a medicine saves the organic 
iron of the food by combining with the sulphur, and so indirectly 
cures the anaemia by the protection afforded the food-iron. It is 
important to remember that each of these theories has been supported 
by many careful experiments, but it is also well to bear in mind that 
the hypotheses and the experiments supporting them may be 
erroneously based. Thus, we have no right to imagine that the 
inorganic preparations of iron have a stimulating power over the ali- 
mentary mucous membrane, or, even if they have, that this power is 
exercised in the peculiar line of aiding in the absorption of the organic 
iron of the food. Again, the researches of Hamburger, Damaskin, 
Gottlieb, Muller, Jacobi, and Socin, which show that after the internal 
use of inorganic iron there is no increase in the iron in the urine, are 
valueless so far as the conclusions drawn by them are concerned — 
namely, that as there is no increase in iron in the urine, there is none 
in the blood, and therefore it is not absorbed. These conclusions 
are not justified, because they are based on the erroneous view that 
because iron is not in the urine it is not in the blood, and because 
it is not in the blood it is not absorbed. Every one knows that in the 
case of chronic lead-poisoning, when the body is saturated with the 
metal, there is often no lead in the urine, the poison being deposited 
in the tissues; and if this is true of lead, it may be of iron. Particu- 
larly is this to be remembered when we find Stockman quoting the 
researches of Mayer, Bidder, and Schmidt, and a host of others, who 
have proved that we are not to look to the kidneys as the path for 
the excretion of iron, but to the intestinal walls. Finally, Stockman 
has proved that when iron is used hypodermically it cures anaemia, 
although it cannot under these conditions stimulate the digestion or 
combine with sulphides. 

We learn from practical experience several things which science 
does not tell us — namely: Iron will not cure all cases of anaemia, 
even if they belong to a functional type, but other methods must be 
resorted to at the same time or separately for their cure. The insoluble 
salts of iron are better remedies for absorption than the soluble salts, 
because they are not precipitated in the stomach, and for this reason 
reduced iron is the best chalybeate for uncomplicated cases. Besides 
using iron in this form, we should employ laxatives if the bowels are 
confined; mineral acids, particularly nitric and nitromuriatic, for their 
effect on the function of the small intestine and liver; and, in addition, 
bitter tonics of a more or less simple form, according to the exigencies 
of the case, using quinine if malaria seems lurking in the body, simple 
bitters if the stomach lacks tone, aromatic bitters if from atony of 
the muscular coats the digestive tract seems sluggish, with a resulting 
formation and accumulation of flatus and digestive juices. 

In many cases of anaemia there exists, either as a cause or effect, 
well-developed intestinal indigestion, and it is thought this results in 
the production of poisons which are responsible for the decrease in 



ANAEMIA. 567 

the corpuscular elements of the blood. The use of laxatives with the 
iron is not only necessary, as already stated, but in addition, to over- 
come this production of toxic products, intestinal antiseptics, such as 
salol and beta-naphthol, are found useful. 

The preparations of iron best employed in anaemia are the insoluble 
salts just named, such as Quevenne's iron and the carbonate, but there 
are indications for each salt which must be regarded. In many 
anaemic persons, particularly females, the tongue is broad and white, 
not from coating, but pallor — is flabby and torpid-looking. Under 
these circumstances the bowels should be kept moving by mild purges, 
and the sulphate or some other astringent preparation of iron be taken 
by the patient. In the anaemia caused by rapid childbearing and 
lactation cod- liver oil, the hypophosphites and lactophosphates of 
calcium, should be used, while iron and quinine in tonic dose may be 
also of service. With some practitioners Blaud's pill is very much 
used, made as follows: 

1$ — Ferri. sulph. exsiccat., 

Potassii carbonatis aa 5ij (8.0). 

Syrupi q. s. — M. 

Ft. in pil. No. xlviii. 

S. — One to three pills three times a day, after meals. 

Although it is perfectly true that we have almost no knowledge of 
the manner in which alteratives act in instances of disease where, 
through morbid functional activity, enlarged glands or growths appear, 
it is evident that they must act upon the trophic nerves or directly 
upon the nutrition of the affected parts. One thing we do know, 
however, and that is that small doses of most of the so-called alterative 
drugs act as very distinct stimulants to the development of normal 
structures, and in no instance do we find this more typically repre- 
sented than in the effect which they exert upon the blood. Quite a 
number of years ago Keyes, of New York, emphasized the value of 
minute doses of mercury bichloride in syphilitic and other anaemias, 
and abundant clinical observation has certainly confirmed his views. 
The dose of bichloride of mercury in anaemia should be about -^ grain 
(0.0015). Not only will minute doses of the bichloride act in this 
way, but small amounts of calomel or mercury itself will have such 
an effect. 

Inunctions of very small amounts of mercurial ointment once a day 
or every other day, in adults and in children, will increase the fulness 
and redness of the cheeks and lips and the number of the corpuscles, 
the piece of ointment used being no larger than the half of a very small 
pea. This treatment will be found of service in cases not necessarily 
dependent upon specific taint. The marked increase in the nutrition 
of children of a syphilitic taint who are suffering from marasmus under 
the internal use of gray powder and full inunctions of mercurial oint- 
ment is most extraordinary. 

Arsenic is also of value in anaemic conditions, and may be employed 



568 DISEASES. 

in relatively larger doses than mercury bichloride. Many clinicians 
have shown the value of this drug in anaemia. Any one of the prepa- 
rations of arsenic may be employed, and should the anaemia be per- 
nicious in its type, or should it depend upon leukaemia or pseudo- 
leukemia, the arsenic must be pushed in ascending doses until 
marked evidences of its general effects are manifested. After this, 
however, most of the drug is in excess and is cast off in the urine and 
feces unused and wasted, straining and irritating the emunctories of 
the body during its passage through them. Arsenic is of particular 
merit in those forms of ansemia in which the blood-cells are lacking 
in number rather than in haemoglobin. 

Arsenite of copper is also a remedy of very considerable value under 
these circumstances in the dose of from y^- to ■£$ grain (0.0006- 
0.003) three times a day. 

A change of air and diet may often produce a cure which no drug 
can bring about. 

Diet is an important part of the treatment of ansemia. The food 
should be good, well flavored, and varied, as well as easy of digestion. 
It should contain, as far as possible, the remedies needed by the sys- 
tem, such as bone salts and iron, and its ingestion should be accom- 
panied by some red wine, such as port. 

At present we are forced to conclude that pathology has not found 
out the real cause of these troublesome cases, and that until physiology 
can put its finger upon the most intricate mechanism of blood-making 
with a positive, clear statement of its function and the physiological 
chemistry of the manufacture of haemoglobin, we must remain satisfied 
to resort to the remedies which experience or common sense tells us 
will be of value to our patients. 

ANAL FISSURE. 

This is one of the most painful affections to which man is subject, 
and requires intelligent treatment, generally by surgical means if the 
result is to be curative, although great relief can be obtained by the 
use of drugs. 

The most annoying feature of the lesion is the intensity of the pain 
on defecation, which is so severe that emptying of the bowel is post- 
poned as long as possible by the patient. 

To relieve this pain and enable the patient to have a fairly com- 
fortable stool, nothing is so good as an iodoform suppository contain- 
ing 2 to 10 grains (0.12-0.60) of the drug. Iodoform being a local 
anaesthetic, the passage may take place with very little suffer- 
ing. If much spasm of the sphincter is present, extract of bella- 
donna, \ grain (0.015), may be added to each suppository. For 
the cure of the fissure a drop of strong carbolic acid may be applied 
to the spot, and a lotion of tannic acid, glycerin, and water used if 
hemorrhoids are also present. Ringer highly recommends the appli- 



ANEURISM. 569 

cation to the fissure, by means of a brush, of a solution of bromide of 
potassium, H drachms to 1 ounce (6.0 : 30.0) of glycerin. In order 
that the passages may be soft and yet the patient not be purged, 
sulphur may be given in the dose of 20 to 40 grains (1.3-2.6) every 
night, or, if this cannot be used, castor oil may be administered. The 
best way to give the sulphur is by combining it with powdered cinna- 
mon or aromatic powder. Sometimes relief is obtained by the use of 
flexile collodion painted over the fissure. Pure ichthyol locally applied 
sometimes does good. The radical means of cure consist in stretching 
the sphincter ani under anaesthesia. This is followed by incising the 
base of the fissure, curetting it, and then touching it with a stick of 
nitrate of silver. 



ANEURISM. 

The treatment of aneurism by drugs is not very successful, but is 
at least worthy of trial in all cases. Vascular disease resulting in 
such a lesion depends upon so many causes which may modify the 
treatment that the history of the case should be carefully considered. 
The most common causes are traumatism and syphilis, and very 
often injury is superimposed upon systemic infection. Whatever the 
cause of the disease may be, iodide of potassium is par excellence the 
remedy most apt to do good, even if it does not cure. The doses 
should be large, 10 to 20 grains (0.60-1.3) three times a day if the 
patient will bear them, and the prognosis under this treatment is far 
more favorable if the cause be syphilis than if the disease be idiopathic 
or traumatic. 

For successful treatment the recumbent position must be insisted 
upon, the patient being kept quiet in bed, changing his position as 
little as possible and confining himself to the most simple and easily 
digested diet, with entire avoidance of all stimulating substances 
either in the way of food or drink. Often it is best to adhere to an 
absolute milk diet. If the heart is excitable and irregular in its 
action, the vascular system irritable, and a high arterial tension is 
present, the circulation must be quieted by small doses of tincture of 
veratrum viride, say 1 or 2 minims (0.05-0.1) twice or thrice a day, 
but digitalis is not to be employed, since it increases the strain upon 
the aneurismal sac, although it quiets the irregular heart beat. Aconite 
may also be used with care, but it is inferior to veratrum viride. If 
the pain be very great — and it often is severe, particularly at night — 
opium is indicated, and sleeplessness should be allayed, not by full 
doses of morphine alone, but by morphine and chloral; or, better still, 
croton-chloral should be so ordered that the patient receives \ grain 
(0.008) of morphine and 10 grains (0.60) of croton-chloral in pill at 
bed-time. All attempts to cure aneurism by the use of other drugs 
unless syphilis indicates mercury, are useless when the lesion is tho- 
racic or abdominal; and when it occurs in the extremities, as in pop- 



570 DISEASES. 

liteal aneurism, pressure or surgical measures are to be resorted to as 
the chief means of cure. If dyspnoea is marked in thoracic aneurism, 
slight inhalations or "whiffs" of chloroform are sometimes useful, as 
is also morphine, given hypodermically in the dose of ■§■ grain (0.008). 

Recently a number of French physicians, chiefly Lancereaux, 
Huchard, and Carnot, have recorded good results in hastening the 
formation of clots in the aneurismal sac by injecting a solution of 
gelatin into the subcutaneous tissues in other parts of the body. The 
formula used is as follows : 

R— Gelatini gr. xxx (2.0). 

Sodii chloridi . . . . gr. cl. (10.0). 

Aquae destillat. . . . fgiv vel fgx (120.0-300.0). 

About 2 ounces (60.0) of this are injected every second day into the 
loose tissues of the back or thighs, a different spot being chosen each 
time. About twenty injections are necessary before marked results 
are obtainable, and absolute rest should be insisted upon. The 
solution used should be carefully sterilized by boiling for several min- 
utes, because the bacillus of tetanus or its spores are often found in 
gelatin, and cases of tetanus in man have followed injections of imper- 
fectly sterilized gelatin. (See Hemorrhage.) 

The author has performed the operation of introducing gold wire 
and using electrolysis in thoracic aneurism a number of times, with 
great benefit to the patient. The operation is indicated in case of 
sacculated aneurism, but never in the fusiform type. This operation 
is the only hope of relief for the advanced sacculated forms of the 
disease. 

ANGINA PECTORIS. 

The exact pathological changes existing in angina pectoris are by 
no means clearly understood, but without doubt many attacks are due 
to spasm of the bloodvessels, which results in distention of the left side 
of the heart, which organ is already dilated or enfeebled by disease. 
Often, too, the coronary arteries have undergone degenerative changes, 
thereby increasing the cardiac debility. Remedies which ordinarily 
relieve pain act too slowly or too feebly to be of service in angina pec- 
toris, and even if successful would only relieve the symptom without 
removing the cause. The indication in the great majority of cases is 
to relax the vascular spasm, thus relieving the overburdened heart. 
As first pointed out by Brunton, the nitrites possess this power, and to 
him belongs the credit of first applying this class of drugs to this ail- 
ment. All the nitrites are useful, but the nitrite of amyl and nitro- 
glycerin are the best remedies for the attack itself, and the nitrite of 
potassium or sodium for the intervening periods or when the paroxysm 
is prolonged. The reason for this lies in the fact that the sodium and 
potassium compounds are more stable than the other two compounds, 
are more slowly broken up in the body, and therefore more prolonged 
in their effects. In an attack a few drops of the nitrite of amyl should 



ANGINA PECTORIS. 571 

be given by inhalation from a handkerchief, or the nitroglycerin can be 
used in the dose of 1 minim of a 1 per cent, solution hypodermically. 
The dose of the sodium and potassium nitrites is 3 grains (0.15) three 
times a day, but all these drugs are useless unless the arterial tension 
is high and the action of the heart labored. 

If vascular relaxation is present, the nitrites should be supplanted 
by stimulants, such as alcohol, in full dose, in warm water. Ether 
given hypodermically is often of service, or Hoffmann's anodyne may 
be used instead of ether by the mouth or hypodermically with better 
results. Digitalone in the dose of 15 minims (1.0) may be given 
hypodermically during the attack to stimulate the heart if it is 
weak, and by the mouth, between the attacks, to improve its con- 
dition. The writer has found 20-grain (1.3) doses of antipyrin 
of great service in some cases. 

If the nitrite does not relieve the pain, or if it cannot be used because 
of some contraindication, morphine must be given hypodermically 
in the dose of J to ^ grain (0.015-0.03), but it should never be given 
by the mouth under these circumstances, as its absorption will be too 
slow and its effects will come on after the pain has ceased. 

The prevention of future attacks rests upon the elimination of all 
causes which can possibly produce a nerve-storm and cardiac irrita- 
bility, and in the administration, if the arterial tension is high, of 
nitroglycerin or one of the other nitrites in full dose for long periods of 
time. As a rule these drugs have to be gradually increased in dose 
in order to maintain their effect. Phosphorus is another remedy which 
is of undoubted value, and should always be tried in the dose of T ^ q- 
grain (0.0006) three times a day after meals. Arsenic is also useful 
as a tonic. 

The following is a valuable prescription for use between the attacks 
if the heart is feeble and the tension high : 

R— Tinct. digital f %) (4.0) vel f giij (12.0). 

Tinct. strophanti . . . n\,xxiv vel f gss (2.0). 

Nitroglycerini (1 per cent.) rr^xxiv (1.6) vel f £j (4.0). 

Tinct. cardamomi . . q. s. f^fiij (90.0). — M. 
S. — Teaspooni'ul (4.0) three times a day. 

The diet should be moderate and easy of digestion, and salads, 
lobster, and similar articles of food avoided. If the patient is inclined 
to take exercise of a violent character he must be restrained, but, on 
the other hand, some gentle exercise may be permitted if it is possible 
to take it without precipitating an attack. 

Tonics, fresh air, freedom from mental worry, and avoidance of 
exposure to cold are also necessary, and running for a car, or per- 
forming any act calculated to increase suddenly arterial pressure and 
cardiac work, is to be avoided. 

In that form of angina pectoris occurring in nervous females, some- 
times called pseudo-angina pectoris, 1 drachm (4.0) of ether in ice- water 
or capsule will often abort the attack, or if the paroxysm is caused by 



572 DISEASES. 

dyspepsia and if the stomach be overloaded, the sufferer may be 
relieved by the stomach-pump. Between the attacks aconite tincture 
in the doses of 6 or 10 minims (0 4-0.60) three times a day is useful. 

ANOREXIA. 

Anorexia, or lack of appetite, is only a symptom of ill health, gen- 
erally associated with debility or other systemic disorder, such as 
anaemia, fever, and many exhausting diseases. It is best treated by 
a well-cooked and daintily prepared diet, the use of the bitter tonics, 
such as gentian, cardamoms, and the mineral acids, or by the use of 
one of the following prescriptions : 

H — Arseni trioxidi gr. J (0.03). 

Extract, nucis vomicae gr. iv (0.25). 

Quininae sulph gi\ xx (1.3). — M. 

Ft. in pil. No. xx. 

S. — One t. i. d. after meals. 

Or, 

1$ — Acid hydrochlorici dil f 5ss (16.0). 

Tinct. cinchonae comp fovj (180.0). — M. 

S. — Dessertspoonful (8.0) three times a day, after meals, well diluted with 
water. 

(For the use of other bitter tonics see Calumba, Quassia, Chamo- 
mile, Cardamom, and Nux Vomica. None of these drugs is suitable 
if there is any acute irritation or inflammation of the stomach or intes- 
tines.) (See Indigestion.) 

APOPLEXY. 

Up to a recent period it has been held that the high arterial tension 
of apoplexy was evil in its effect because it increased the extravasation 
of blood through the leaking vessel, and for this reason venesection has 
been commonly employed. Studies carried on by Kocher, in Berne, 
and by Cushing, in Baltimore, seem to indicate that this high arterial 
tension is an effort of nature to drive sufficient blood into the cranium 
to maintain the circulation in the brain, which would otherwise be 
impaired by the pressure of the extravasated fluid, for great inter- 
cranial pressure depresses the vasomotor centres and with its failure 
the vital centres nearby fail to receive an adequate supply of blood. 
Some surgeons have advocated opening the cranium and removing 
the clot. The objection to this plan is that the soft tissues of the brain 
have been irreparably damaged by the rushing of the blood from the 
inflamed vessel. The condition is quite different from that found in 
meningeal hemorrhage. 

With our present knowledge it is probably best to use measures 
which are helpful and not radical. 

Hot mustard plasters must be applied to the feet, or a hot mustard 
foot-bath be used if this is practicable. Ice in an ice-bag or wrapped 



APOPLEXY. 573 

in a towel may be applied to the head. If vomiting comes on, care 
must be taken that the stertorous breathing does not draw into the 
lungs particles of the half-ejected food. Sometimes croton oil, 1 
minim (0.05), placed on the tongue with 5 minims (0.3) of sweet oil 
may cause a depletant catharsis which will relieve cerebral engorge- 
ment, or J grain (0.01) of elaterium may be used. The head must 
be kept high and the feet low. These are the methods to be used 
immediately after the rupture of the bloodvessel. 

The objects to be sought, after the "stroke" has occurred and the 
hemorrhage has ceased, are the removal of the extra vasated blood, the 
restoration of function in the paralyzed parts, and the prevention of 
secondary lesions consequent upon inflammation of the brain as a 
result of the injury to its substance. If the patient survives the attack, 
no drugs should be used for one or two days, until the clot in the 
ruptured vessel has become firmly fixed, unless symptoms of cerebritis 
arise, when vascular sedatives, such as aconite, must be pushed if the 
pulse is tense, and calomel administered in small doses, \ grain (0.015) 
of each every four hours. After the clot has firmly formed and has 
plugged the leak in the bloodvessel, we may proceed to take measures 
for the absorption of the exudate, the chief measure consisting in the use 
of iodide of potassium in as large doses as the patient will bear without 
the production of iodism. This drug should not be resorted to until 
several days, or even two or three weeks, have elapsed after the attack. 
Mercury in small doses may also be given. 

In order that the muscles of the extremities may not waste and 
become powerless from disuse, passive exercise, rubbing, and, if pos- 
sible, massage, must be resorted to. Electricity may be applied to 
them in the form of the slowly interrupted current, and strychnine 
may be used hypodermically or by the mouth as a stimulant to the 
trophic centres in the spinal cord. None of these measures is to be 
employed if any inflammation exists in the brain, as they will increase 
the cerebral disorder, and at least three weeks should elapse after the 
attack before they are resorted to. (See Strychnine.) 

Electricity applied to the head to remove the lesion is useless, as 
the current does not go through the brain, but around the skull by 
means of the scalp. 

A very careful diet is to be maintained. Meats are to be used very 
sparingly, the bowels maintained in perfect regularity, and no wines 
are to be taken nor any stimulants used lest they cause a second 
rupture of the weakened vessel in the brain. 

Apoplexy must be carefully differentiated from acute alcoholism 
and opium-poisoning, which it much resembles. (See Alcohol.) 

If respiration fails, nothing can be done with much advantage, but 
belladonna or strychnine may be given hypodermically. The use of 
electricity to stimulate the phrenic nerve and diaphragm when respi- 
ration fails is a remnant of senseless medical practice, and is partic- 
ularly useless in apoplexy. (See Asphyxia.) 



574 DISEASES. 

Above all things, stimulants are contraindicated during the acute 
attack, even though the pulse fails, as they increase the hemorrhage 
into the brain. 

If the symptoms of apoplexy are produced by an embolus, bleeding 
is usually useless, and it may be harmful by decreasing arterial pressure 
and thereby delaying the establishment of collateral circulation. 

APPENDICITIS. 

It is to be remembered that many cases which years ago would have 
been called idiopathic peritonitis are now recognized as arising prima- 
rily from inflammation of the appendix vermiformis. For this reason 
it is incumbent upon every physician who is called to see a case of 
severe abdominal pain with symptoms of peritonitis or appendicitis 
to examine carefully into the condition of the appendix. No routine 
treatment for appendicitis can be followed, as each case possesses dis- 
tinct individuality. There are many surgeons, holding extreme 
views, who assert that the mere presence of appendicular inflammation 
for a few hours renders an extirpation of this organ necessary. On 
the other hand, there are doubtless many cases in which the physician 
postpones consultation with a surgeon until it is too late to save the 
patient. All cases of appendicitis may be divided into three classes: 
First, those which are fulminating or gangrenous, and very frequently 
result in death whether treated medically or surgically; second, those 
which will get well if they receive surgical aid; and third, those which 
undoubtedly get well, some of them permanently so, under proper 
medical treatment. With the first class we shall not deal, for obvious 
reasons, except to say that they should be promptly operated upon in the 
hope that they may be saved. In all cases of acute appendicitis of the 
third class which we have named the method to be followed is briefly 
as follows : The patient is to be put to bed and absolute rest on the back 
insisted upon. He must not rise to the sitting posture even for defe- 
cation or urination. An ice-bag is to be placed over the appendix, or, 
if this cannot be done, leeches may be applied in this region. If 
constipation has been present so that the bowels are loaded with feces, 
this should be removed by the use of half to one ounce of magnesium 
sulphate or magnesium citrate in official solution, but it is far better to 
unload the colon by rectal injections. After the bowels have been 
moved, sufficiently large doses of opium or morphine are to be given to 
relieve pain if it is severe enough to be agonizing. The doses 
should be of such size as to "take the edge off the pain," but they 
must not stupefy the patient, so that he fails to give clear answers to 
questions. If in spite of this treatment there is persistent tenderness 
in the right iliac region, with increase in the area of dulness on per- 
cussion over the appendix, and on palpating the abdomen a sense of 
muscular rigidity exists, then a surgeon should be at once called in — 
not, necessarily, to operate, but to decide as to the advisability of an 



APPENDICITIS. 575 

operation, and to perform it if it is considered a wise procedure. Gen- 
erally, it is best to postpone surgical interference in mild cases until 
after the acute attack is over, but this preference is to be waived in 
pressing cases, where then are a rapid pulse, rigidity of the belly, and 
great pain. 

In the second class of cases which we have named the treatment is 
too largely surgical to be considered in a book devoted only to medical 
therapeutics. It is unnecessary to give a purgative before the opera- 
tion, unless we think the bowel contains undigested food, since the 
caput coli never contains feces in any quantity, and, furthermore, in 
those fairly severe cases which demand operation at once the possibility 
of perforation of the appendix, with escape of the contents of the 
bowel into the peritoneal cavity, is always to be remembered, for if 
perforation has occurred the purgative will force the feces out through 
the patulous appendix. 

In this connection it is of interest to consider the plan instituted by 
Ochsner, and w^hich has given results which demand attention. The 
determination of the character of the treatment to be carried out rests 
upon the condition of the appendix at the time the patient is seen. 
His views are best described as follows: 

1. Patients suffering from chronic recurrent appendicitis should be 
operated on during the interval. 

2. Patients suffering from acute appendicitis should be operated 
on as soon as the diagnosis is made, provided they come under treat- 
ment while the infectious material is still confined to the appendix, if a 
competent surgeon is available. With this opinion the author differs, 
because statistics show that a greater percentage of cases recover if 
operation is postponed until the interval than if operated on at once. 
Immediate operation is, however, required in fulminant cases. 

3. In all cases of acute appendicitis without regard to the treatment 
contemplated the administration of food and cathartics by mouth should 
be absolutely prohibited and large enemata should never be given. 

4. In case of nausea or vomiting or gaseous distention of the abdo- 
men, gastric lavage should be employed. 

5. In cases coming under treatment after the infection has extended 
beyond the tissues of the appendix, especially in the presence of begin- 
ning diffuse peritonitis, conclusions 4 and 5 should always be employed 
until the patient's condition makes operative interference safe. 

6. In case no operation is performed, neither nourishment nor 
cathartics should be given by mouth until the patient has been free 
from pain and otherwise normal for at least four days. 

7. During the beginning of this treatment not even water should be 
given by mouth, the thirst being quenched by rinsing the mouth with 
cold water and by the use of small enemata. Later small sips of very 
hot water, frequently repeated, may be given, and still later small sips 
of cold water. There is danger in giving water too freely, and there is 
great danger in the use of large enemata, 



576 



DISEASES. 



8. All practitioners of medicine and surgery, as well as the general 
public, should be impressed with the importance of prohibiting the 
use of cathartics and food by mouth, as well as the use of large enemata, 
in cases suffering from acute appendicitis. 

9. It should constantly #)e borne in mind that even the slightest 
amount of liquid food of any kind given by mouth may give rise to 
dangerous peristalsis. 

10. The most convenient form of rectal feeding consists in the use 
of one ounce of one of the various concentrated liquid predigested 
foods, dissolved in three ounces of warm normal salt solution intro- 
duced slowly through a soft catheter inserted into the rectum a 
distance of two or three inches. 

11. This form of treatment cannot supplant the operative treatment 
of acute appendicitis, but it can and should be used to reduce the mor- 
tality by changing the class of cases in which the mortality is greatest 
into another class in which the mortality is very small after operation. 
To this plan the author would add the use of normal saline solution 
by hypodermoclysis, with the object of allaying thirst and flushing the 
kidneys. , 4 

If attacks of appendicitis are recurrent, the appendix should always 
be removed in an interval of quiescence. (See article on Peritonitis.) 

ASPHYXIA. 

When practising artificial respiration in cases of asphyxia Sylves- 
ter's method should always be employed. This consists of laying the 
patient on some hard, flat surface, kneeling above his head, and then, 

Fig. 102. 




Sylvester's method of artificial respiration. First movement: the patient's arms are placed at 
right angles to the trunk, the elbows resting on the floor, to expand or inflate the chest. 



after grasping the arms at the elbows, bringing them upward and 
outward, so that they follow the plane on which the body is extended. 
This movement causes expansion of the chest, or inspiration. After 



ASPHYXIA. 



577 



a moment's pause the arms are lifted up and brought toward one 
another, and then, while still approximated, pushed down to their 
original position upon the floating ribs, upon which they are pressed. 
This last movement drives out the air from the chest, or causes expi- 



Fig. 103. 




Sylvester's method of artificial respiration. Second movement: the patient's arms are drawn 
toward the physician, in order to expand the chest still further. 

ration. These movements should be at the rate of from sixteen to 
twenty per minute, about that of normal respiration, and be persisted 
in for at least forty-five minutes, even though the case seems hopeless, 

Fig. 104. 




Sylvester's method of artificial respiration. Third movement: the patient's arms are raised 
and the elbows approximated to contract the chest. 

as cases have recovered after as long a period of apparent death as an 
hour. While these movements are being carried on, the patulousness 
of the upper air-passages is to be maintained, if possible, by the meas- 
ures described below. 

37 



578 



DISEASES. 



In some researches made by Dr. Martin and the writer the following 
rules regarding the position of the head, neck, epiglottis, and tongue 
were formulated: The fingers are passed behind the angles of the 
lower jaw and the latter is pressed forward; this elevates the epiglottis 



Fig. 105. 




Sylvester's method of artificial respiration. Fourth movement : the patients elbow and fore- 
arms are pressed forcibly upon the floating ribs to expel the air from the chest. 

and the base of the tongue about a quarter of an inch from the post- 
pharyngeal wall. Extending the head and pushing it forward so that 
the neck makes an angle of forty-five degrees with the plane of the 
table draws the base of the tongue and the hyoid bone far forward, this 

Fig. 106. 




Showing the attitude in which the head should be held to permit the easy passage of air 
through the glottis. This position raises the epiglottis, and lifts the soft palate from the tongue. 
(Martin and Hare's method.) 

motion being at the same time imparted to the epiglottis, so that the 
latter stands upright and is separated from the posterior wall of the 
pharynx by an interval of about an inch. By tightly closing the jaw 
the anteroposterior space is still further increased. 



ASTHENOPIA. 



579 



A very useful method of treating asphyxia is Laborde's method by 
rhythmic traction on the tongue. The tongue is grasped with forceps 
and pulled well forward and upward from ten to fourteen times a 
minute until voluntary respirations occur. The sensory nerves of the 
tongue carry impulses to the phrenic centre, which in turn causes the 
diaphragm to contract. A very large number of recoveries from 
apparent death as a result of its use renders this method most worthy 
of trial. 

Fig. 107. 




Illustrating how upward traction on the tip of the tongue draws the epiglottis away from the 
glottic opening and permits free ingress of air. It also shows how letting the tongue fall back 
in the mouth in anaesthesia would close the air-passages and permit the epiglottis to interfere 
with breathing. (From a research by Dr. Martin and the author.) 

The absurdity of the application of the rapidly interrupted electric 
current to the phrenic nerve is not alone dependent upon the points we 
have named. (See Ether.) It has recently been proved by careful 
observation on the part of Dr. Martin and the author that the applica- 
tion of the electrode over the phrenic nerve in the neck may cause 
cardiac arrest through diffusion of the current to the vagus nerve, and 
Griswold reached conclusions of an identical character in 1885. 

If electricity is used, it should be employed solely as a peripheral 
irritant, with the object of arousing the patient, as would a dash of 
cold water. 

ASTHENOPIA. 

Asthenopia, or weak sight, depends upon exhaustion of the power 
of accommodation in cases of refractive error, usually hypermetropia, 
or upon insufficiency of the external ocular muscles. The former is 
sometimes called accommodative asthenopia, and the latter muscular 
asthenopia. The treatment of these conditions requires the prescrib- 
ing of the proper pair of glasses, combined, if necessary, with prisms 
and with systematic exercise of the ocular muscles. Locally, a weak 



580 DISEASES. 

solution of the sulphate of eserine or pilocarpine acts as a stimulant 
to the ciliary muscle, and good results follow the internal use of large 
doses of the tincture of nux vomica or strychnine. 

1^— Eserinse sulph gr. -^ (0.016). 

Aq. destill. f gj (30.0).— M. 

S. — 2 drops (0.1) night and morning. 



Or, 



1$ — Pilocarpin. nitrat. gr. ^ (0.003). 

Aq. destill fgj (30.0).— M. 

S. — 2 drops (0.1) night and morning. 



Another form of asthenopia is termed neurasthenic asthenopia, or 
retinal anaesthesia, and presents a number of eye-symptoms in con- 
nection with a general depression or debilitated state of the nervous 
system, the eye itself, however, being a healthy organ. The chief 
symptoms are fluctuation in visual acuity, rapid disappearance of 
objects looked at, contraction of the field of vision, imperfect retinal 
images, often associated with dread of light. The mere prescription 
of glasses in these cases to correct any refractive error is not sufficient. 
Much relief will often be obtained if compresses at 110° F. be applied 
to the closed eyelids for five minutes at a time. The patient requires 
the same general treatment that would be applied to any neurasthenic 
case. All the functions of the body must be carefully examined into 
and placed in as normal a condition as circumstances will allow. 
Especially valuable are rest, massage, salt baths, and full doses of 
strychnine, together with iron if there be ansemia. 

ASTHMA. 

Asthma is one of the most difficult diseases to treat successfully that 
the physician has to deal with. 

The disease in all its forms depends upon interference with the free 
entrance to and exit of the air from the lungs, and this is generally, if 
not always, dependent upon a spasm of the muscular fibres in the 
walls of the bronchial tubes, although it has been asserted to be due to 
a sudden swelling or hypersemia of the bronchial mucous membrane. 
Both of these states are probably present in varying degree in all 
cases. 

The spasm has been proved by Longet, Williams, Romberg, Paul 
Bert, Bierner, and more recently by Sandmann, to be due to a neu- 
rosis of the pneumogastric or vagus nerve, and the swelling of the 
mucous membrane has been seen by Stoerk and others. Thus two 
schools of teaching concerning the pathology of this disease have been 
formed, when a little attention to the physiology of the subject would at 
least show that no difference need exist, for the vagus nerves govern 
not only the muscular fibres, but also the bloodvessels of the bronchial 
tubes. The discovery of Michaelson that injury of the recurrent 



ASTHMA. 581 

laryngeal nerves causes catarrhal inflammation of the bronchial tubes, 
particularly those of the upper lobes, renders the analogy between 
acute asthma and laryngeal spasm, which has been spoken of by many 
writers, still more interesting. 

One other step remains for a thorough understanding of the man- 
ner in which the disease is produced. Gastric, dyspeptic, or intestinal 
asthma arises from indigestion, as its name implies, and is caused by 
the irritation of the afferent filaments of the vagus in the walls of the 
stomach and intestine, thereby causing reflexly a contraction and 
hypersemia of the bronchial tubes. In a similar reflex manner hyper- 
trophies of portions of the nasal chambers or abnormal conditions of 
the nasal mucous membranes in general may result in an asthmatic 
attack. 

Having obtained some idea of the cause of an attack, let us turn to 
the treatment of the affection. 

One of the most serviceable remedies in asthma is belladonna, 
which, as has been pointed out when that drug was studied (see Bella- 
donna), exercises in medicinal dose a decided sedative and depressing 
influence on the peripheral filaments of the vagus nerves, not only so 
far as the heart is concerned, but also, through the pulmonary fibres, 
upon bronchial secretion, which is always diminished by the drug, 
probably by this vagal influence. 

It is evident, therefore, that the use of belladonna or atropine, 
although originally employed in an empirical manner, rests upon a 
rational basis, and as the physiological action of stramonium, hyoscy- 
amus, and similar members of this group is nearly identical with that 
of belladonna, their influence for good is also explained. The experi- 
ments of Ott prove that lobelia is a peripheral pneumogastric depressant, 
and those of Rosenthal and the author likewise showed that tobacco 
has a similar effect. The same is also true of nitrite of amyl and the 
other nitrites, which also relax unstriped muscular fibre. We have 
before us, therefore, a list of the most efficacious and best anti- 
asthmatics, all of them being depressant to the peripheral vagi. 

The other remedies commonly employed are chloroform by inhala- 
tion, which relaxes the spasm of muscular fibre by its local influence, 
and morphine, which acts as a nervous sedative, prevents reflex irri- 
tation, and quiets the patient, acting at the same time as a heart stim- 
ulant and unloading the engorged cardiac cavities. The relief obtained 
by the inhalation of the fumes of nitrate of potassium, See asserts, 
depends upon the formation of the protoxide of nitrogen and carbonic 
acid gas, which act as local anaesthetics. 

The practical treatment of an attack of asthma consists in the use 
of morphine hypodermically in the dose of -g- to J grain (0.01-0.015), 
alone or in combination with atropine. Cigarettes made of paper 
soaked in a solution of nitrate of potassium and belladonna may be 
smoked (see formula under Belladonna), or they may be made in the 
following manner: 



582 DISEASES. 



1$ — Foliorum belladonna? 



Foliorum hyoscyami 
Foliorum stramonii 
Extracti opii 
Aquae laurocerasi . 



gr. vj (0.40; 
gr. iij (0.2). 
gr. iij (0.2). 
gr. J (0.015). 
q. s. — M. 



These various leaves are broken up like commercial tobacco, and 
moistened by adding the cherry-laurel water, which should contain 
the opium. Finally, a whole leaf soaked in the same fluid is used as 
a cover, or a piece of cigarette paper may be employed in the same 
manner. 

In some cases a very useful treatment is the smoking of nitre-paper 
cigarettes, which are prepared, before rolling, not only by soaking the 
paper in a solution of nitrate of potassium (see Nitrate of Potassium), 
but also by dipping them, after drying them, in tincture of belladonna 
or stramonium, and allowing the alcohol to evaporate from the paper 
while it is hung in the air. 

Another remedy recently brought forward in this country for the 
relief and cure of asthma is euphorbia pilulifera, the fluid extract of 
which may be given in the dose of \ to 1 drachm (2.0-4.0) once, twice, 
or thrice a day. (See Euphorbia Pilulifera.) 

The author finds the following formula very useful in asthma : 

I$— Sodii iodidi gr. ij (0.12). 

Potas. bromidi gr. ij (0.12). 

Ext. euphorbia? pilulifera? fl tt\,iij (0.20). 

Nitroglycerin! gr. ^ (0.0003). 

Tr. lobelia? TT\> (0.25).— M. 

Ft. in tabel. vel capsul. No. i. 
S.— From 1 to 4 three times a day. 

If desired, this formula may be given in the form of an elixir. It 
will be seen that each ingredient of this recipe has a different action. 
The action of the iodides in asthma is well known, as is also that of the 
bromides. The euphorbia pilulifera has been found useful in asthma 
empirically. The nitroglycerin depresses the peripheral ends of the 
vagus nerves, and acts as a stimulant to the heart when engorged with 
blood by removing the inhibitory action of the vagus and relieving the 
bloodvessels elsewhere. The tincture of lobelia acts as a depressant 
to the vagus also. 

A valuable prescription for asthmatics to take between the attacks, 
particularly in those cases which have cardiac symptoms, is the one, 
calling for digitalis, strophanthus, and nitroglycerin, in the article on 
Angina Pectoris. 

Sometimes a cup of strong coffee taken at the beginning of a par- 
oxysm will abort it. 

The use of amyl nitrite by inhalation, 3 to 6 minims (0.20-0.4) on 
a handkerchief, is invaluable in many cases, and it rarely fails to 
relieve the spasm. Owing to the engorgement of the heart conse- 
quent upon the embarrassment of respiration, this nitrite must be used 






ASTHMA. 583 

with care, and in one or two instances it has proved dangerous by 
causing cardiac failure. 

Sometimes tobacco may be smoked, and it is particularly efficacious 
in those who are not accustomed to its constant use. 

Lobelia when employed should be us£d in full emetic dose (2 
drachms [8.0]), in the form of the tincture if an attack is imminent. 
If an attack is feared, 20 minims (1.30) of the tincture every four 
hours may be given if the heart is in good condition. 

A treatment of asthma which is very successful when it arises from 
nasal disorder consists in the application to the nasal cavities, at the 
onset of the attack, of the following solution by means of a brush or 
spray : 

1$ — Cocain. hydrochloridi gr. xv (1.0). 

Aquae destillat q. s. ad f 5iv (16.0). — M. 

S. — Apply as directed. 

If this solution is thoroughly applied and the other directions given 
are carried out, very rapid relief will often be obtained. Under no 
circumstance is the patient to be allowed to make these applications, 
for if he does so he is almost certain to develop the cocaine habit. 
The physician should make them and not reveal the nature of the 
drug used. Unfortunately, we cannot readily separate those cases 
which are due to nasal disease and those produced by other causes, 
and in consequence this treatment when tried for the first time in a 
given case is purely experimental unless we can discover some hyper- 
sesthetic patch in the mucous membrane. 

The curative treatment of asthma to a very large extent rests upon 
the use of iodide of potassium, and in the careful regulation of the 
diet and bowels, particularly if the trouble seems to be dependent 
upon indigestion. As the attacks are generally nocturnal, the even- 
ing meal should be taken early, be light and easily digested, and tea 
and coffee should be avoided at this time. The patient should avoid 
dusty streets and live in the open air as much as possible, and a damp 
atmosphere is usually preferable to a dry one, provided it is not too 
cold. This rule is subject to many variations, and each case will be 
found to be a law unto itself. Each patient must try different climates 
until the proper one is found. Arsenic may be used, particularly if 
the mucous membranes are below par, and a dose of bromide of potas- 
sium or sodium, 30 grains (2.0) half an hour before retiring may be 
of service. 

Grindelia robusta is largely used as a prophylactic in the dose of 
10 to 30 minims (0.60-2.0) of the fluid extract three times a day. 
Lobelia may also be used in the form of the tincture, 20 minims 
(1.30) three times daily. 

The use of compressed and rarefied air is sometimes of service. 
Inhalations of oxygen are valuable if the cyanosis is extreme. 

In many cases the greatest relief will be given by the use of the 
bronchitis-tent. (See Bronchitis.) 



584 DISEASES. 

In those cases in which the presence of nasal polypi or other irrita- 
tions of the air-passages is the exciting cause of the attacks those 
causes must be removed before a cure can be attained. In other 
instances arsenical wall-papers are the cause of the trouble. In all 
cases of asthma the physician should from time to time examine the 
urine and the heart to determine if the attacks are due to disease of the 
kidneys or to congestion from cardiac failure. 

BED-SORES. 

Bed-sores depend upon disturbances of nutrition resulting from 
pressure exercised in such a manner that the local circulation is inter- 
fered with at a time when the vitality of all the tissues is depressed 
by disease or injury. In most instances the part involved becomes 
chafed by creases in the sheets, by crumbs of food, or by moisture 
from the discharges of the rectum and bladder. Bed-sores can usually 
be avoided by cleanliness unless they are dependent upon disease of 
the trophic nervous system. 

The chief indication is to prevent the trouble by careful nursing and 
cleanliness, which should be supplemented by measures devoted to the 
hardening and improving of the nutrition of the skin covering the parts 
where the sores are apt to appear, as over the buttocks and sacrum. 
To permit of a good supply of blood, the patient should be turned on 
one side or the other every few hours and the skin of the part which 
has been pressed upon rubbed thoroughly with a dry towel to cause a 
healthy transudation and absorption of the nutritive juices. Salt and 
whiskey, 2 drachms (8.0) to the pint (480.0), may be rubbed over the 
skin, and tincture of gambir or the dilute solution of the subacetate of 
lead applied to harden it. If this is not used, a mixture of alum and 
spirit of camphor is useful, made by adding 1 ounce (30.0) of pow- 
dered alum to the whites of 4 eggs and mixing this with 2 ounces (60.0) 
of the camphorated spirit. Where the skin is very red and angry- 
looking, but still intact, a solution of nitrate of silver of the strength 
of 20 grains to 1 ounce (1.3:30.0) is to be thoroughly painted over the 
spot. All these remedies act by hardening the skin through their 
astringency, or by acting as sedative astringents to the inflamed but 
relaxed capillaries of the part. 

When a bed-sore is developed, measures must be taken for its cure 
and the prevention of its spread. With this object in view the body 
must not rest on the part affected if this can possibly be avoided, and 
in order that the sore may be protected and the pressure equalized, a 
large piece of soap-plaster, with its edges deeply incised to make them 
pliable, should be applied after the sore has been thoroughly washed 
out by means of a swab or syringe filled with a 1 : 5000 solution of 
bichloride of mercury, and afterward dusted with iodoform or with 
chloretone and boric acid in equal parts. Sometimes large squares 
of lint thickly covered with zinc ointment are serviceable in lieu of 



BILIOUSNESS. 585 

the soap-plaster. If the sores spread and burrow through the parts, 
the sinuses should be freely opened and irrigated with peroxide of 
hydrogen, all dead tissues being cut away to avoid sepsis. 

Nitrate of silver in the strength of 20 grains to the ounce (1.3:30.0) 
may also be used locally as the patient recovers if the ulcers seem 
sluggish. A smooth slip-sheet should always be placed under the 
buttocks. If possible, supportive measures and an increased amount 
of predigested food should be given if the sloughs are large. The 
internal use of iron is particularly valuable in the form of the tincture 
of the chloride in full doses (say 20 minims [1.3]) every four hours. 

BILIOUSNESS. 

This is a term used to designate a state which presents different 
symptoms in different cases, but always includes languor, headache, or 
dizziness, perhaps some yellowing of the skin and conjunctiva, and a 
general sense of atony, mental depression, and discomfort. It depends 
not upon an excessive secretion of bile, but upon some perversion of 
the functions of the liver or the retention of bile in the bile-ducts. 
Further than this, most of the symptoms do not depend directly upon 
the changes in the bile, but upon failure of proper digestion in the 
stomach and intestine, coupled with the development of irritative 
decomposition-products of various kinds. The stomach, intestine, 
liver, pancreas, and their juices all form a complex interwoven chain 
of function in which if one link breaks the entire chain becomes dis- 
turbed. The entrance into the stomach of certain food-stuffs which 
are either ill-prepared or improper for gastric digestion rapidly causes 
the development of active fermentation, with the formation of lactic 
and butyric acids, which irritate the gastric mucous membrane, and 
thereby bring about a faulty gastric secretion of mucus, which makes 
still further trouble. By the same means the circulation of the stomach 
is disturbed and becomes abnormal, and the intestine, liver, and pan- 
creas receive reflex irritation to which they are not normally exposed. 
Further than this, the irritated stomach fails to convert its contents 
into peptones and the general features of chyme, and too early or too 
late drives out into the duodenum a mass of semidigested and fer- 
menting material utterly unfit for intestinal digestion and absorption, 
thereby disordering the functions of these parts still further at a time 
when they are not prepared for the reception of any food. The secre- 
tion poured out by the different glands varies from the normal; the 
alkaline juices are not able to overcome the normal acid of the gastric 
juice plus the lactic and butyric acids; and finally the reaction of 
the intestine becomes acid instead of alkaline, with resulting irritation 
and secretion of morbid juices and mucus. The trouble when existing 
in the stomach gives rise to headache and discomfort, a bad taste in 
the mouth, and perhaps pain, and is followed by fever, languor, jaun- 
dice, and flatulence when the intestine is affected. The cause of these 



586 DISEASES. 

symptoms rests upon the fact that, while gastric juice and bile are 
antiseptic, pancreatic juice mixed with food undergoes rapid decom- 
position, with the development of products of decomposition, such as 
skatol and indol and a large number of poisonous alkaloids. Nor- 
mally, these are not allowed to form, owing to the presence of anti- 
septic bile, which also hurries on the absorption of the food; but if 
the bile is retained in its ducts, its secretion is impaired and its consti- 
tution altered by the disorder of the liver which results reflexly from 
the gastric and intestinal irritation. Unfortunately, the complication 
does not cease at this point, for the liver in health has other functions 
to fulfil, one of the most important of which is the arrest and destruc- 
tion of all poisons of an organic character which come to it from the 
stomach and bowel. Not only are decomposition-products destroyed 
by it, but all the vegetable alkaloids are rendered innocuous if present 
in ordinary amounts. 1 The disorder of hepatic function therefore 
permits the entrance into the general circulation of these substances, 
which are very various as regards their powers and effects. Thus, 
Brunton has pointed out that one of these compounds closely resembles 
curare, in that it poisons the peripheral ends of the motor nerves, and 
thereby is at least partly responsible for the muscular relaxation and 
languor often seen in patients suffering from so-called "biliousness." 
Other substances act as do digitalis, atropine, muscarine, and picro- 
toxin, and the number of these various compounds is infinite. 2 

It is impossible to give space to a further consideration of these 
poisons, but what has been said shows clearly that " biliousness" only 
expresses a state in which absorption of the bile is not the sole cause 
of the symptoms, but that other poisons are at work. The methods 
of treating biliousness are therefore not to be considered as depending 
upon some regular routine, but upon a study of the case and its symp- 
toms. 

Very frequently, after several days of minor discomfort, the disorder 
culminates in a severe sick headache, after which vomiting comes on 
and relief is obtained almost at once. Such patients can generally be 
relieved in the very first part of their discomfort by emetic doses of 
ipecac or apomorphine, 30 to 60 grains (2.0-4.0) of the former, or 
Y3- grain (0.004) of the latter hypodermically, or by means of lavage. 
The manner in which this treatment does good is very evident. It 
compresses the liver and expels inspissated bile by the compression 
exercised by the abdominal walls and diaphragm in the effort of 
vomiting, and thoroughly excites to normal secretion the torpid glands 
of the stomach and intestine. 

The vomiting or lavage also rids the stomach of the fermenting 
masses and bacteria contained in them, and renders the alimentary 

1 See studies of Schiff, Lautenbach, and many others, including Ludwig and Schmidt- 
Mulheim. 

2 See the researches of Schweringer, Zuelzer and Sonnenscheim, Bence Jones, Dupre, Rorch 
and Fassbender, Brieger, Schmiedeberg, and Harnach. 



BILIOUSNESS, 587 

canal more pure. This purity may be increased by giving draughts 
of hot water or hot water containing a few grains of bicarbonate of 
sodium or salicylic acid. 

When it becomes evident that an attack is about to begin — that is, 
when constipation, slight drowsiness, or languor after meals shows 
the tendency present — one of two drugs should be used, either podo- 
phyllin if the stools be dark, or calomel if they be light-colored: ^ 
grain (0.01) of the former to an adult is generally enough, or 1 grain 
(0.06) of calomel divided into six powders, one of which is to be taken 
every fifteen minutes, is a good dose, to be followed in four hours by 
a saline. If the attack is sudden in its onset, no time is allowed for 
these hepatic stimulants, and a saline purge should be used in a good- 
sized dose at once, not because it causes a flow of bile, but because 
it sweeps the poisonous matters out of the gut before complete ab- 
sorption can occur, and aids in restoring the normal intestinal alka- 
linity. 

The prevention of "biliousness" depends upon the maintenance of 
a normal, easily digested diet, upon the formation and excretion of 
normal bile, and the prevention of fermentation and decomposition 
in the alimentary tract. 

The term "normal diet" is a very elastic one, and varies with each 
case. While certain forms of food are generally considered good or 
bad, easy of digestion or difficult of assimilation, it nevertheless remains 
a fact that many of the simplest foods are capable of acting as poisons 
in susceptible persons. A large number of persons cannot take milk 
or eggs oecause their digestion of these substances is faulty, and the 
writer is cognizant of one case where lobster salad can be eaten at bed- 
time without discomfort, while an egg at breakfast will cause a severe 
headache or pain in the belly. Coffee is often the cause of bilious- 
ness. Rules as to diet must not be "ironclad," but based on observa- 
tion. 

By far the best means of maintaining hepatic activity in cases where 
this organ is torpid is horseback exercise, particularly if the exercise 
is taken on a trotting horse, as the jolting of the liver keeps the chain 
of digestive functions active and prevents the secretions from becoming 
clogged. Along with this exercise massage of the hypochondrium 
and belly- walls is useful, and the movements of stooping over, bending 
from side to side, and bending backward with the feet close together, 
are of value. 

The use of pure (undiluted) nitromuriatic acid in these cases in the 
dose of 3 minims (0.20) three times a day in half a tumblerful of water 
is invaluable, and the fluid extract of stillingia in the dose of 20 minims 
(1.3) is of service, as is also the solid extract of euonymus in the dose 
of 3 grains (0.20.) Five-grain (0.30) doses of extract of chirata in pill 
are also useful in pepatic atony of a mild type. 



588 DISEASES. 



1$ — Ext. chiratse .... 
Podophyllin .... 
Euonymin . 

Leptandrin 

Creosoti 

Ft. in pil. No. xx. 


. . . gr. xl (2.6). 
. . . gr. iv (0.25). 
. . . gr. viij (0.5) 
. . . gr. viij (0.5) 
. . . gr. x (0.60). 


S. — One pill every night. 





-m; 



The knowledge of the action of many of the poisonous materials 
formed in the alimentary canal renders it possible for us to relieve the 
patient by other means than those which may be generally resorted to 
when the attack is present. Thus if the pulse be slow and full, the 
arterial tension high, and there is throbbing in the head, with frontal 
headache, the alkaloid representing digitalis may be antidoted by the 
use of aconite. If nervousness and irritation are present, the bromides 
and chloral may be used. 

For some unknown reason the use of caffeine in the headaches of 
biliousness nearly always makes them worse, particularly if the head- 
ache is due to overindulgence in coffee. (See Headache.) 

If the face is flushed, a mustard plaster or dry cup to the nape of the 
neck may be used, and a hot foot-bath is often of service. 

In cases where the bilious attacks are associated with catarrh of 
the stomach, intestines, or bile-ducts, chloride of ammonium, in 5- 
grain (0.3) doses, three times a day, is very useful, as is also the pro- 
tiodide of mercury, when triturated with sugar of milk, in the dose of 
"ST to TU g ram (0.001-0.0015) three times a day. Frequently the 
use of salol or salophen in 10-grain (0.60) doses, three times a day, 
does much good in these cases, acting as an intestinal antiseptic. (See 
Salol.) 

BLEPHARITIS. 

Blepharitis is divided clinically into an ulcerative and a non-ulcera- 
tive variety. The indication of prime importance in the treatment 
of this affection is the removal of the scabs and crusts before the 
application of the local remedies. This may be accomplished by 
the use of alkaline solutions, bicarbonate or biborate of sodium 
(8 grains to the ounce [0.50:30.0]), or a 5 per cent, solution of 
chloral, as recommended by Gradle. The salves that have met with 
the greatest success are Pagenstecher's ointment (yellow oxide of 
mercury, 1 grain (0.06); vaseline, 1 drachm [4.0]), dilute citrine oint- 
ment, pyrogallic-acid ointment, or a 3 per cent, milk-of-sulphur oint- 
ment, to which resorcin may be added. The latter application is 
useful in the squamous variety alone. In the ulcerated form, if the 
crusts are tenacious, these, as well as the stunted cilia, must be removed 
with forceps, and yellow-oxide-of-mercury salve, or some similar 
application, applied. Excellent results follow touching with nitrate 
of silver the crater-like abscesses in the edges of the lid. If there 
is an accompanying conjunctivitis, a boric-acid solution is suitable, 
while under any circumstances obstruction of the lachrymal duct 



BOILS. 589 

— a frequent accompaniment of the disease — must be removed and 
the nasal passages explored for any chronic inflammatory condition. 
The relation between this disease and the presence of refractive errors 
demands the correction of the latter, should these exist, before a 
hope for cure may be entertained. 

BOILS. 

Boils are dependent upon an impoverished state of the system, or, 
more rarely, on some local trouble situated in the skin, as in the persons 
of oil- or paraffin- workers. 

The constitutional treatment rests upon the use of fresh air, cod- 
liver oil, iron, arsenic, phosphate of sodium, and, if any boils are 
present, the use of the sulphurate of calcium in the dose of T ^ grain 
(0.006) every five hours. The sulphurate of calcium hastens the matura- 
tion of boils and prevents the formation of new ones, but is useless, 
according to its original user, Dr. Ringer, in the boils which appear 
during the course of some cases of diabetes. 

The local treatment of boils may be divided into the abortive and 
curative methods. The abortive method consists in painting the 
inflamed spot, when the trouble first begins, with solution of gun- 
cotton (collodion), and renewing the coat hour after hour until a 
heavy contractile covering is formed. If pus forms under this, it may 
be absorbed; but if this does not occur, then the boil must be opened 
under antiseptic precautions and properly dressed. A strong solution 
of nitrate of silver is also very useful at the beginning of the forma- 
tion of a boil if painted over the part in the strength of 20 grains to 
the ounce (1.3:30.0). The other local applications consist in the 
use of the extract of opium or belladonna over the part to relieve pain 
and decrease the inflammation. 

Poultices may also be used to relieve the sensation of tenseness and 
mature the boil, and should contain sweet oil and laudanum. Ringer 
recommends the application of alcohol and camphor over the skin in 
the ettdy stages. After the skin is wiped dry it is to be smeared with 
camphorated oil. Stelwagon uses the following: 

3— Ichthyol 5j (4.0). 

Emplast. plumbi oij (8.0). 

Emplast. resinse (U . S. P. 1890) . . . 5ij (8.0).— M. 
S.— Apply to the part. 

He also approves of the injection of a few minims of a 5 per cent, solu- 
tion of carbolic acid into the apex of the boil if its formation is assured. 
When boils occur in the external ear, the canal should be frequently 
irrigated with hot water, and if the boil is mature it is to be incised. 
A useful pain-relieving dressing for the boil is as follows : 

R — Iodoform gr. iv (0.25). 

Menthol gr. ij (0.12). 

Petrolati £j (4.0).— M. 

S. — Smear on cotton plugs and insert in the ear twice or thrice a day. 



590 DISEASES. 



BREAST (INFLAMED). 



Lactation should at once cease and the milk be removed by the aid 
of massage and the breast-pump. A bandage exercising pressure is 
now applied and an ice-bag placed over it. This is only useful in 
those cases in which the glands are the part affected. When the con- 
nective tissue is involved, lead- water and laudanum should be applied, 
and saline purgatives used. Belladonna ointment may be smeared 
over the breast with advantage in both forms to check secretion and 
allay inflammation. As soon as pus has formed it should be set free 
by an incision in the line of the ducts. If it be deeply situated, it 
should be incised close to the chest and the pockets opened by 
grooved director or dressing-forceps and packed with gauze. 

In the early stages of the inflammation, if the circulation is bounding, 
it should be thoroughly impressed by aconite or veratrum viride and 
belladonna. 

BRONCHITIS (ACUTE AND CHRONIC). 

In the early stages of bronchitis there is always present a very dis- 
tinct hyperemia, followed by a true inflammation of the mucous 
membrane lining the bronchial tubes. When these changes are con- 
fined to the larger bronchi the term " bronchitis " is employed, but 
when the minute bronchioles are invaded the disease is known as 
" capillary bronchitis." In the article on Pneumonia, and elsewhere 
in this book, the writer has spoken of the various stages of inflamma- 
tion, the . measures indicated under such circumstances, and has 
described the action of the various drugs. In many cases the phy- 
sician only sees the patient when the second stage of the disease is 
present, but if the individual presents himself promptly, the following 
history and physical signs will indicate the treatment to be employed: 
After exposure, more or less severe, to wet, dampness, or dry cold, a 
sensation of oppression comes on, associated with a feeling of "tight- 
ness across the chest" or a sensation as if a bolus of food was under 
the sternum. Aching and pain may then be traced over the lines of 
the bronchial tubes, while the dry, hacking cough increases the dis- 
comfort and seems to strain the tubes till each one can be outlined on 
the chest- wall by the patient. The cough, when it occurs, is virtually 
unproductive, and often causes pain in the larynx and throat. On 
making examination by auscultation there will be found over the 
posterior aspect of the chest, between the shoulder-blades, sounds 
of bronchial breathing, which are rougher than normal, and due to 
the air passing over an inflamed, swollen, and roughened mucous 
membrane. This bronchial roughening may be sufficient to cause 
a harsh inspiratory sound over the entire chest, and the expiratory 
sounds may be heard a little louder than usual. No other changes 
from the normal can be noted, but isolated spots of discomfort may 






BRONCHITIS {ACUTE AND CHRONIC). 591 

be pointed out by the patient, where aches, "catches/' or "kinks'' 
seem to be present in a previously normal tube. Percussion, palpation, 
and inspection show nothing more of note. Some fever may be present. 
The patient should receive a hot foot-bath, take a glass of hot lemon- 
ade with a little whiskey in it, and go to bed at once, in order that, by 
inducing a profuse perspiration, he may relieve the bronchial con- 
gestion. Often a dose of Dover's powder is useful in hearty adults to 
aid in causing perspiration. In children the chest should be well 
rubbed with camphor liniment and a little tincture of aconite be given 
in water with sweet spirit of nitre every hour, as follows : 

I$— Tinct. aconit n\,xxiv (1.50). 

Spt. aether, nitros 1 . . f oij (8.0). 

Aquae destillat q. s. ad i'oj (30.0).— M. 

S. — A half-teaspoonful (2.0) to a child or a dessertspoonful (8.0) to an adult 
in water every hour 

In many adults 5 to 10 grains (0.3-0.60) of Dover's powder, with a 
hot drink, are better. 

If the attack is not aborted while the first stage is still present, 
before secretion is established, resort should be had to ipecac and to 
citrate or acetate of potassium, which act as sedatives to the inflamed 
mucous membranes and aid in the formation of secretion, moistening 
the inflamed surfaces and thereby overcoming the dryness and irrita- 
tion. These potassium salts also act as febrifuges, and should be used 
in full doses, as much as 40 grains to 1 drachm (2.6-4.0) in a day, 
in addition to the aconite already recommended. The following 
prescriptions illustrate their employment: 

1$ — Syrupi ipecacuanhae f3j vel f5iij (4.0-12.0). 

Potassii citratis 5iv (16.0). 

Aquae destillat q. s. ad f ^vj (180.0). — M. 

S. — Dessertspoonful (8.0) every four hours for a child of five years. 

Py — Syrupi ipecac f B j (30.0). 

Succi limonis f §j (30.0). 

Potassii bicarbonatis 3iv(16.0). 

Spirit, aether, nitrosi f oj (30.0). 

Aquae destillat q. s. ad fgvj (180.0). — Tvi. 

S. — Dessertspoonful (8.0) every four hours for an adult. This mixture should 
not be corked for some time after it is made. 

For a child this prescription should be reduced just one-half in each 
part, with the exception of the water. 

In some cases, particularly if the patient be a child, large doses of 
the citrate or other salt of potassium exert a depressing influence and 
have to be decreased. 

Counterirritation may be applied to the chest in the shape of a 
mustard or spice plaster. If the soreness of the bronchial tubes is not 
relieved by this means, inhalations of steam arising from boiling water 
may be practised, either through a cone, one end of which covers the 
top of a pitcher and the other end of which covers the mouth and nose 



592 



DISEASES. 



of the patient, or by covering the head and pitcher with a towel. The 
usefulness of this method may be much increased by the addition of 1 
tablespoonful of compound tincture of benzoin to each pint of water. 

In young children, particularly in the first stage of bronchitis and in 
the later stages, the use of the so-called "bronchitis- tent" is of great 
value. It consists of a canopy raised over the bed a sufficient distance 
to allow of the circulation of plenty of air. Through one side of this 
canopy passes a tube leading from an Arnold steam sterilizer, under 
which is an alcohol lamp to keep the temperature of the water suf- 
ficiently high. (Fig. 108.) By this means the air breathed by the 
patient is so saturated with moisture that the mucous membrane 



Fig. 108. 




Bronchitis-tent put up by aid of two sheets pinned together and four broomsticks lashed 
to corners of bed. The steam arises from an Arnold steam sterilizer to which has been attached 
a tube. When in operation the side flap of the tent is dropped. 

lining the air-passages is soothed and quieted. In order that the full 
benefit of this measure be understood, it must be remembered that a 
mucous membrane in the early stages of inflammation is always dry 
and red, lacking its normal moisture, and that the upper air-passages 
fail to catch upon their surfaces, by reason of their dryness, particles 
of dust, and do not moisten the air before it reaches the lungs. Again, 
it will be remembered that the bronchial mucous membrane is cov- 
ered with ciliated epithelium, which, by the constant, upward, wavy 
motion of its cilia, urges out of the lungs all impurities. Dryness of 
the surface at once stops this ciliated movement, with unfavorable 



BRONCHITIS {ACUTE AND CHRONIC). 593 

results. The employment of the "bronchitis-tent" is equally useful 
in adults, but less readily employed, owing to the size of the bed. 

Having considered the treatment of the first stage of bronchitis, we 
pass to that of the second. The condition of the mucous membranes 
is now quite different from that which has just been spoken of. 
In the place of an absolute lack of secretion a profusion of cast-off 
epithelial cells, a large amount of mucus, and more or less liquid 
have been poured out upon the walls of the bronchial tubes, forming 
obstructions everywhere to the ready passage of air. The secretion is 
apt to be more or less viscid and ropy, and, when it is coughed up 
after considerable effort, appears in lumps, particularly in the morn- 
ing. This state is one in which the excitement of inflammation is 
followed by local depression and an effort on the part of the tissues to 
rid themselves of the congestion and of the useless epithelial forma- 
tions. The physical signs on listening to the chest are now found to 
consist in a large number of loose rales, which are distinctly wet and 
moist. Later they become markedly liquid and bubbling, and so cause 
gurgling on inspiration and expiration. Sometimes they are musical 
or squeaking. Generally the latter signs do not come on until the case 
is far advanced, and, if a cure is soon to be reached, they last only a 
few days or hours, as the mucus is so loose as to be easily coughed up 
and the lung readily cleared. 

The object of the physician is to use remedies which will stimulate 
the bronchial tubes and increase the volume of liquid poured out. 
For this purpose the bronchitis-tent may of course be employed, but 
the drugs to be used internally are the chloride of ammonium and the 
pitches and turpentines, such as terebene, or even turpentine itself. 

In the majority of instances an ammonium mixture will be the best 
and most serviceable prescription, in one of the following forms: 

B — Ammonii chloridi . . . . . . . 5ij (8.0). 

Ext. glycyrrhiz. fluid f 5ij (8.0). 

Aquae destillat q. s. ad fgiij (90.0). — M. 

S. — Teaspoonful (4.0) to dessertspoonful (8.0) every four hours. 
Or, 

1$ — Ammonii chloridi 3ij (8.0). 

Mist, glycyrrhiz. comp f §iij (90.0). — M. 

S. — The same dose. 

The advantage of the latter prescription is the presence of antimony in 
the compound liquorice mixture, which tends to increase secretion, but 
which is contraindicated if debility exists. 

If the cough is troublesome, a little morphine or belladonna may be 
added, or the following be used, particularly if any signs of cardiac 
failure appear: 

1^ — Ammonii chloridi 5j (4.0). 

Ammonii darbonatis • 5j (4.0). 

Ammonii bromidi 5j (4.0). 

Extract, glycyrrhiz. fluid f §iv (16.0). 

Aquae destillat fgvj (180.0).— M, 

S .— -Dessertspoonful (8.0) every four hours. 

38 



594 DISEASES. 

In this prescription the first constituent acts particularly on the air- 
passages, the second stimulates the heart and respiration, and the 
third allays the cough, while the liquorice masks the salty taste of the 
ammonium. Still another recipe is: 

1$ — Codeinse sulphatis gr. ij vel iv (0.12-0.25). 

Ammon. chlorid 3j (4.0). 

Ext.glycyrrhiz.fi fgj (30.0). 

Aquae destillat q. s. ad fgij (60.0).— M. 

S. — Teaspoonful (4.0) every two hours in water. 

An oronasal respirator, with the sponge saturated with equal parts 
of terebene, iodide of ethyl, and chloroform, may be worn in order to 
allay cough and loosen the mucus. Sometimes the use of a nebulizer, 
as shown on page 522, is very useful, or Yeo's inhaler may be used. 
(See Creosote, Part II., and Inhalations, Part III.) 

If the administration of the chloride of ammonium does not aid in 
the expulsion and liquefaction of the secretion and rid the lungs rapidly 
of the mucus, the use of terebene in 5- or 10-minim (0.30-0.60) cap- 
sules may be resorted to with success. If capsules cannot be sup- 
plied, terebene may be made into an emulsion with acacia or trag- 
acanth and given in this way. Sometimes terebene will irritate the 
kidneys and produce a sense of weight across the loins; if this occurs, 
its use should be stopped. In other cases it will disorder the stomach 
or cause diarrhoea. These effects are not, however, commonly seen. 
Terpine hydrate in 10-grain (0.60) doses may be used three times a 
day, or terpinol in the dose of 8 to 10 grains (0.5-0.60) in capsules or 
pills. An excellent combination is the elixir of terpine hydrate with 
heroin, which may be given in the dose of a dessertspoonful (8.0) every 
four hours in a little water. Certain of the volatile oils and resins are 
also of value at this time, notably the oleoresin of cubebs and copaiba, 
which, however, possess the disadvantage of disordering the stomach. 
The oil of eucalyptus is also of great value, and may be given in capsule 
or emulsion in the dose of from 1 to 5 minims (0.05-0.30) every five 
hours. The oil of sandalwood in the dose of 5 to 10 minims (0.30-0.60) 
is very valuable, and is not so apt to disorder the stomach, bowels, and 
kidneys as are some of the other remedies named. 

While the proper use of these remedies usually brings about the 
results desired, in some cases a stage of profuse secretion comes on 
which in its treatment is identical with that seen in chronic bronchitis, 
and chronic "winter cough" with emphysema, so these diseases will 
therefore be considered together. 

In old persons suffering from dilated bronchial tubes, from emphy- 
sema, and from chronic bronchitis there is constantly poured into the 
air-passages so free a secretion that persistent coughing is necessary 
to rid the lung of enough of the mucus and liquid to enable them to 
breathe. Any excess of this exudation drowns him in his own secre- 
tions, and the constant obstruction to the ready flow of air and blood 



BRONCHITIS {ACUTE AND CHRONIC). 595 

in the lung soon produces dilatation and weakness of the right side of 
the heart. 

The same condition in a more acute form sometimes asserts itself 
in young children and in adults. In children it sometimes comes 
on so suddenly as to be known as " acute suffocative catarrh/' while 
in older persons it appears with sufficient severity to make the con- 
dition of the patient most serious. Of the treatment of the latter 
state the writer will speak at once. 

The objects desired are to rid the lung of the liquid secretions, to pre- 
vent the outpouring of more exudate, and to support the patient until the 
crisis is past. Digitalis should be administered to support the heart, and 
strychnine be employed in full dose to stimulate the respiratory centre 
and excite the nervous system, which is generally depressed by the 
increasing carbonic acid in the blood. For the same purpose caffeine 
or strong coffee may be used. Oxygen may be inhaled, and to check the 
profuse secretion atropine should be used by the mouth or hypoder- 
mically. When cyanosis is marked and the patient is a child, it 
may be alternately dipped in a tub of hot and cold water to cause 
reaction and stimulate the dormant nerve centres to greater activity, 
and so by reviving the patient sufficiently respiration is maintained 
until voluntary efforts are made by the patient. Sometimes letting 
the patient hang his head over the side of the bed when he coughs 
may aid in the expulsion of the liquid. 

The treatment of the more moderate condition of excessive secre- 
tion in the bronchitis of old persons, which is more slow in its progress, 
but which may end as fatally as like attacks in the young, is some- 
what similar to that just given. Injurious results are often produced 
by the physician failing to recognize that the secretion is sufficiently 
fluid, and that ammonium chloride and such expectorants are not only 
useless, but distinctly harmful because they increase the quantity of these 
liquids. Under these circumstances the application of several dry cups 
over the bases of the lungs posteriorly often gives a great deal of relief ; 
or if cups cannot be obtained, then active counterirritation by means of 
a mustard-plaster or turpentine stupe is advisable. The cups are, 
however, the remedy of choice. Belladonna, which checks secretion, 
stimulates the respiratory centre, and is for this reason a doubly useful 
remedy. Strychnine is, however, the best of remedies to help the 
patient get rid of the sputum. It should be given in the dose of -^V 
grain (0.006), or more, three times a day. When the condition is 
pressing atropine and strychnine should be used hypodermically. 

The use of remedies designed to allay the cough in these cases is 
absolutely unjustifiable, as it results in retention of the profuse secre- 
tion. The question as to whether the cough is excessive or not must 
depend on the ability of the lungs to rid themselves of the secretions 
in the bronchial tubes. 



596 DISEASES. 



BURNS AND SCALDS. 

The treatment of burns and scalds is both internal and external, 
the first being devoted to the quieting of the nervous system after the 
injury, the relief of pain, and the treatment of shock; and the second 
to the care of the injured surfaces. Immediately upon being called 
to a severe case of burn it is the duty of the physician to determine 
how badly shocked the patient is, what the condition of the pulse may 
be, and whether or not the lungs and air-passages are involved. After 
these mental notes he should give a hypodermic injection of \ to § grain 
(0.015-0.03) of morphine and ^ho of atropine (0.0006), and then roll 
the entire body in a large quilt to maintain the bodily heat, while the 
sufferer is being transferred to the hospital or the house to which he 
belongs. 

In some cases the shock is so great that the pulse flags at once, the 
temperature falls, and collapse ensues. Stimulants hypodermically, 
external heat, and drinks of hot water and whiskey are indicated, fol- 
lowed by y-o grain (0.003) of strychnine and 5 minims (0.3) of tincture 
of digitalis if the circulation does not respond to the less powerful 
stimulants. Adrenalin chloride, 1 drachm (4.0) of a 1 : 1000 solution, 
may be given intravenously in a pint of normal saline solution in 
severe cases. A very useful treatment under these circumstances is 
to immerse the patient in water hot enough to maintain the bodily 
temperature. Often while in this bath the burned cuticle is easily 
removed with but little pain, and the protection from the air decreases 
dermal irritation. 

By far the best dressing is lint wrung out in a mixture of picric acid. 
(See Picric Acid, Part II.) Another useful application is linseed oil and 
lime-water, equal parts, or, if desired, the oil may be rendered antiseptic 
by the addition thereto of 1 part of carbolic acid to 20 parts of oil. This 
mixture is also of service in that it acts as a feeble local anaesthetic. 
The cloths should be renewed every twelve or twenty-four hours, as 
may be needed, or they may be substituted by lint wrung out in a 
saturated watery solution of boric acid. A useful application for 
severe burns is a dusting-powder composed of: 

1^ — Chloretone, 

Acid, borici aa gss (16.0). — M. 

S. — Dust the injured surface with this powder and dress it with dry gauze. 

Still another very efficacious application to burns is that of the 
late Professor Rice. It is better than Carron oil or any of the prepa- 
rations ordinarily used. It is as follows: 

fy— White gelatin gviiss (225.0). 

Glycerin. . . f 5j (30.0). 

Carbolic acid f 3j (4.0). 

Water fgxvj (480.0). 

Soak the gelatin in the water until it is soft; then heat it on a water-bath 
until it is melted. Add the glycerin and continue heating until a firm, glossy 
skin begins to form on the surface of the mixture, in the intervals of stirring. 
Now add the carbolic acid and mix intimately. 



CHANCROID. 597 

This mixture may be kept ready prepared, and is best preserved in 
well-closed glass or porcelain jars. When wanted for use, it is heated 
on a water-bath until just melted, and applied with a soft flat brush 
over the burned part, where it forms a strong flexible skin. 

If the burn is not very extensive, a solution of the tincture of canthar- 
ides, 1 part to 40, upon a rag, is said to relieve pain and aid in healing, 
but if the burned surface be large this treatment should not be resorted 
to, owing to possible irritation of the kidneys, which are already over- 
taxed by the interference with the functions of the skin. In compara- 
tively small burns a saturated solution of carbonate of sodium (wash- 
ing soda) often does great good in relieving the pain. This relief 
may depend on the solvent power of this salt upon albuminous deposits, 
formed by the heat, which irritate the peripheral nerves. 

A very important point in the subsequent treatment of burns is the 
remembrance of the close relationship existing between the internal 
organs, particularly the duodenum and the kidneys, and the cuticle. 
When we recollect that we try to influence internal congestions — such 
as pulmonary congestion, for example — by the application of irrita- 
tion to the skin of the chest, we see at once that a widespread and 
severe burn is practically a huge counterirritant and must reflexly 
affect the viscera. 

Again, the skin, being prevented from excreting impurities, forces 
the kidneys to do the work, and if they fail under the strain 
death results. Whenever the urine is high-colored and cloudy the 
citrate of potassium should be freely given, 20 grains (1.3) in water 
three times a day, combined with 30 minims (2.0) of sweet spirit of 
nitre. 

In dressing very severe burns the use of a general anaesthetic, such 
as chloride of ethyl by inhalation, or chloroform, is proper, but it 
must be used with great caution. 

CHANCROID. 

The chancroid is a contagious ulcer which has no definite period of 
incubation, is distinctly inflammatory in type, and is usually multiple. 
It is further distinguished from the primary sore of syphilis by the fact 
that it is autoinoculable, is not followed by secondary eruptions, and, 
if it involves the lymphatics at all, produces an acute inflammatory 
swelling which frequently attains a considerable size and suppurates. 

Chancroid, being purely a local affection, would seem to require 
nothing more than local treatment : this is true of the uncomplicated 
sore, but where phagedena or serpiginous ulceration sets in, the ques- 
tion of constitutional treatment is of paramount importance. 

The treatment of uncomplicated chancroid in its early stage is as 
simple as it is efficient. One thorough cauterization converts the sore 
into a healthy ulcer the cicatrization of which is quickly and surely 
accomplished. 



598 DISEASES. 

As the most efficient means of thoroughly destroying chancroidal 
ulcerations the actual cautery is chiefly commended. This is, how- 
ever, objectionable to patients. Sulphuric or nitric acid will be found 
equally serviceable. The pain of these applications may be greatly 
lessened by the previous employment of a 20 per cent, solution of 
cocaine. When the surface involved is large, the patient should be 
etherized. The cardinal point in the cauterization of chancroids is to 
reach and destroy all the diseased area. Each pocket and sinus must 
be thoroughly acted upon, otherwise it remains as a focus for reinfec- 
tion. A convenient way of both destroying the chancroid and pro- 
viding for the after-dressing is offered in the application of Ricord's 
paste. This is made by adding to finely powdered charcoal enough 
strong sulphuric acid to form a paste of about the consistency of castor 
oil. This is then applied to every portion of the ulcer. The acid 
shortly dries out, leaving a dressing of charcoal, which in a few days 
drops off, exposing a healthy, nearly healed, granulated surface. 
Where nitric acid is applied the subsequent dressing consists, 
preferably, in the application of dusting-powders, iodoform being 
the best. 

There has been a tendency of late years to substitute for this treat- 
ment one less radical, more acceptable to the patient, and in many 
cases almost equally satisfactory in results. It is certainly true that 
many of the chancroids as found in persons of robust health show 
little tendency to spread beyond comparatively narrow limits, and are 
amenable to mild treatment. It must be remembered, however, that 
as long as the smallest portion of such an ulcer remains unhealed it 
may at any time take on all the features of a virulent ulceration. 
Moreover, the patient is constantly exposed to the risks of a chan- 
croidal bubo — a complication so troublesome that the possibility of 
its development constitutes the strongest argument against palliative 
in distinction from radical treatment. 

Where the ulceration is entirely superficial, constituting the erosive 
form of chancroid, iodoform, dusted over the surface of the carefully 
cleansed granulations, offers the best form of palliative treatment. 
As a cleansing and stimulating wash to precede the application of the 
iodoform, 1 drachm (4.0) of nitric acid to the pint (480 c.c.) of water 
is most satisfactory. The objection to iodoform lies in its disagreeable 
and penetrating odor. To overcome this, great care should be exer- 
cised in applying the powder to see that none is distributed elsewhere 
than upon the sore. The odor can also be disguised to some extent 
by thoroughly mixing with the iodoform a small quantity of one of the 
essential oils, such as oil of peppermint, or attar of roses, using not 
more than 5 minims (0.30) to 1 drachm (4.0) of the powder. There is 
no dusting-powder which can entirely take the place of iodoform, yet, 
when the objections to the use of the latter are insuperable, aristol or 
iodol may be substituted, or a mixture of 1 drachm (4.0) of zinc oxide 
and 3 drachms (12.0) of snbnitrate of bismuth, or equal parts of calo- 



CHANCROID. 599 

mel and bismuth. Where the discharge is profuse, powdered tannin 
may be combined with the dusting-powder in the proportion of 1 
part to 4. 

In the ordinary uncomplicated chancroid these dry dressings are 
greatly to be preferred to wet applications: when, however, the sore 
is attacked by a high grade of inflammation and becomes indurated, 
prolonged immersion of the part involved or of the whole body in hot 
water may be followed by the application of dressings kept constantly 
wet with the dilute nitric-acid lotion, as given above, or with weak 
carbolic solution, 5 grains to the ounce (0.30 : 30.0) of water, or with 
lead-water and laudanum. Where the chancroid assumes the phage- 
denic type, extending with great rapidity and causing extensive slough- 
ing and destruction of tissue, free cauterization, either with the hot iron 
or by means of nitric acid, should be instituted immediately, every 
portion of the ulcerating surface being thoroughly destroyed. This 
should be followed by prolonged hot sitz-baths or general warm baths, 
the patient remaining in the water for days at a time if necessary, and, 
if practicable, eating and sleeping with the body still immersed. If 
this is not possible, baths of from two to four hours' duration should 
be given two or three times daily. After cauterization, powdered 
iodoform is the best local application in phagedenic cases. In addition 
the patient may be given full doses of opium, and should receive a 
tonic and supporting treatment. 

Should the chancroid assume the serpiginous type, slowly extending 
in spite of treatment, till in the course of months or years large areas 
are destroyed by the process, the warm bath, continued night and day 
for weeks at a time, together with thorough cauterization of the entire 
diseased surface with the hot iron, represents the most satisfactory 
method of treatment. In all such cases a thorough trial should be 
given to the treatment appropriate to tertiary syphilis. 

The chancroidal bubo is best avoided by prompt and thorough 
cauterization of the sore: when it occurs, however, it should be first 
treated by rest, pressure, and counterirritation, since it may be a 
simple inflammatory adenitis, and with care may not go on to sup- 
puration. Iodine may be painted around the swollen area, the patient 
should be put to bed, and a compress should be applied wet with dilute 
lead- water and alcohol, and held in place by a spica bandage of the 
groin, or this may be substituted by a hot bag placed upon the inflamed 
gland. At the first sign of suppuration the bubo should be punctured 
by a tenotome, evacuated, and washed out with a bichloride solution 
(1:1000), and dressed antiseptically. If there be a reaccumulation 
of pus, the puncture and washing should be repeated. If inflamma- 
tory symptoms still persist, the diseased gland should be thoroughly 
removed by dissection or the curette through a free opening, the 
resulting wound being drained by gauze and sutured. If the bubo 
takes on phagedenic action, it should be treated as the phagedenic 
chancroid. 



600 DISEASES. 

CHOLERA, ASIATIC. 

The treatment of this exceedingly dangerous disease is prophylactic, 
curative, and convalescent. 

The first measures consist of strict quarantine, both public and 
private, the avoidance of all water for culinary purposes which has not 
been boiled at least an hour and cooled in a place devoid of germs, 
the use of no uncooked food which may be contaminated, and the 
employment of those foods which, while preserving the normal bodily 
health, in no way predispose to intestinal disturbances, as do some of 
the fruits, as melons and grapes. If these precautions are observed, 
little remains to be done; but sulphuric acid may be taken as a pro- 
phylactic. 

The use of a remedy originally proposed by Dr. R. G. Curtin has 
been proved by recent study to be eminently rational. This agent 
is sulphuric acid. This drug not only is acid, and so deleterious to 
the bacillus, but, in addition, is astringent, and is probably elimi- 
nated as a sulphate by the lower bowel. As is well known, ordinary 
cholera morbus yields readily to its influence. 

Dividing the disease into three stages, we find as the earliest symp- 
tom some disturbance of peristaltic movement, with or without pain, 
or in other instances the patient is attacked with a sudden flux of the 
intestinal contents. If there is a history of the ingestion of bad or 
indigestible food, there is no doubt whatever that this foreign material 
must be gotten rid of by the use of castor oil or sulphate of magnesium, 
the latter being the best because it is more rapid and less apt to cause 
griping. No purgative should be given unless the history of the 
ingestion of bad food is most direct and clear. 

When the attack is sudden in its onset, as is usual, the question 
arises, Shall we resort to opium by the mouth? The answer, after 
having carefully considered the statements of a large number of 
authors, is that opium should not be used by the mouth or hypoder- 
mically except in cases where the pain or cramps are so severe as abso- 
lutely to require the drug. In other words, it is to be given for the 
pain, not for the diarrhoea. Should opium be used, it is infinitely 
better to employ it by the rectum in the manner to be described later; 
and if it is necessary to use it by the mouth, only deodorized opium 
or deodorized laudanum should be employed, since these preparations 
are less apt to cause nausea than their fellows. 

Camphor, on the other hand, seems to be universally regarded as a 
most useful drug, tending at once to check diarrhoea and relieve the 
pain and cramps from the beginning to the end of the attack. Whether 
camphor exercises any germicidal effect on the cholera bacillus we do 
not know. Certain it is that volatile oils all possess distinct antiseptic 
powers. Aside from any such influence, camphor is useful as a gen- 
eral systemic stimulant, and has been proved by wide clinical observa- 
tion to have a very extraordinary power in the control of all forms of 






CHOLERA, ASIATIC. 601 

serous diarrhoea, particularly that of true cholera. The spirit of camphor 
has proved most effective in cholera epidemics. Frequently the use 
of camphor so controlled the diarrhoea and stimulated the torpid kid- 
neys that anuria was relieved in twenty-four hours. Under these 
conditions camphor wine has been found very useful; it is made 
by adding 75 grains of finely powdered camphor to a quart bottle 
of strong red wine, to which are also added gum arabic and alcohol. 
The camphor is first dissolved in the alcohol, and then thoroughly 
mixed with the wine. The dose of this mixture is a tea spoonful, 
in peppermint tea, every hour to a child of six years, for an older 
child a dessertspoonful, and for an adult a wineglassful. Those who 
first used this mixture were wiser than they thought, for the recent 
studies of Pick have shown that both red and white wine are dis- 
tinctly inhibitory to the growth of the spirillum of cholera, probably 
because of the tannic or other acid which they contain, as well as the 
alcohol. 

A remedy, the use of which is based on very rational grounds, is 
salol, and probably the newer drug salophen, which, theoretically, is 
much better than the former, because it is less poisonous. According 
to the interesting studies of Lowenthal, salol seems to be peculiarly 
antagonistic to the bacillus of cholera. This investigator added to a 
50-gramme alkaline solution of pancreatic juice 10 grammes of salol, 
and to tins mixture 3 cubic centimetres of a virulent bouillon culture of 
the bacillus. Examinations in forty-eight hours to a week showed this to 
be absolutely sterile. It was further proved that the salol was inactive 
until broken up into its component parts — phenol and salicylic acid. 
Hueppe also asserts that the use of salol prevents the development of 
anuria. 

In addition to the treatment already given, which may be used in 
the second as well as in the first stages, we have measures which must 
be resorted to for the relief of the dominant symptoms which mani- 
fest themselves as the disease progresses. 

The symptoms now to be combated are vomiting, excessive purging, 
cramps in the extremities, and, as the result of these, exhaustion, 
collapse, and the advent of the algid stage. By far the best results 
obtained by any one line of treatment at this time certainly follows 
the employment of salol and camphor by the mouth, with enteroclysis 
and the use of hot baths ; or, if these are not possible, hypodermoclysis 
and the employment of a hot- water bed; or, finally, hot bottles and 
bricks, for the patient largely dies of cold and of internal congestion 
of thickened blood, the circulation of which the heart and vasomotor 
system are unable to control. Atropine and strychnine are very 
useful, but ether is better than either, given subcutaneously or by 
the mouth, as a diffusible stimulant. 

Very remarkable results are said by Italian observers to follow 
the rectal injection of a solution of common salt in the proportion of 
1 drachm to the pint (4.0 : 480 c.c.) of warm water. In other instances 



602 DISEASES. 

the use of tannic acid in the strength of from 1 to 8 drachms to the pint 
(4.0-30.0 : 480 c.c.) of water has proved very satisfactory. The amount 
used at each injection should be about 2 quarts (960 c.c), and the 
injection made as gently as possible in order to urge the fluid high 
into the bowel. The inflow tube should be a soft female catheter, 
and the overflow tube twice as large as the inflow tube. The tubes 
are to be' inserted side by side, after thorough oiling. The injection 
may be used every two hours and continued till the outflow is clear. 
This is done to wash out poisonous materials and to supply liquid to 
the system. A solution much stronger or weaker than that named is 
dangerous, for similar reasons to those given under the head of Dropsy 
and Saline Purgatives. (See, also, Enteroclysis, Part III.) 

Another useful measure is hypodermoclysis, or the passage of a 
solution similar to that just named into the subcutaneous tissues of 
the thigh or belly- wall. It should always be practised if collapse is 
present. (See Hypodermoclysis, Part III.) If made slowly, these 
injections are absorbed readily and supply liquid to the depleted blood- 
vessels. (See article on Diarrhoea.) 

CHOLERA INFANTUM. 

Cholera infantum is a term often applied to all forms of active 
serous diarrhoea afflicting children in the summer months, whether its 
cause be exposure to high heat, the use of bad food, or both. The 
treatment by the use of drugs is identical in all forms of serous diarrhoea 
in children as far as the purging is concerned, but the cause requires 
great care in its discovery and skill in its removal if that be possible. 

Diarrhoea occurring in an infant in hot weather is to be regarded by 
the physician as a fireman regards a fire. The only way to prevent 
a calamity is to regard it seriously and use every effort to prevent its 
further development. 

In cities, where the heat is often great, the air damp and impure, 
and the food not always fresh, cholera infantum often appears as a 
form of thermic fever or heat-exhaustion, or, in other words, as sun- 
stroke. Often in these cases the temperature in the rectum will be 
found febrile, while that of the axilla is below normal, and, as pyrexia 
does harm to the internal organs, the internal temperature must be 
lowered by cool drinks, by administering pieces of ice, and the irriga- 
tion of the bowel which will be described shortly. The diarrhoea 
in such cases is dependent upon a relaxation of the bloodvessel walls 
in the intestine by reason of the influence of the high heat upon the 
splanchnic nerves, and to irritant matters derived from germs and result- 
ing from defective secretion of the digestive juices. If the thermometer 
placed high up in the rectum shows a subnormal temperature, heat- 
exhaustion is present, not thermic fever, and the treatment is reversed. 
Hot drinks are to be used, external heat applied, and friction of the 
limbs resorted to, or the child may be put in a hot bath at a temperature 






CHOLERA INFANTUM. . 6Q3 

of 103° F., the child's temperature being carefully watched lest it rise 
suddenly to a point above the normal. Avoidance of milk and the use 
of a few drops of beef-juice in water for twenty-four hours are the best 
orders as to diet. If vomiting is active and collapse is threatened, a 
drop or two of good brandy should be used in each teaspoonful of 
food, and the value of atropine and adrenalin as vasomotor stimulants 
is not to be forgotten. 

There is another form of cholera infantum which is not due to a 
high atmospheric temperature alone, but more commonly to the 
ingestion of irritant foods or foods unsuited to a child, obtained by 
the patient surreptitiously or through the ignorance of the parents. 
If there is such a history and the probable cause is discovered by 
reason of some of the masses of undigested food having been passed, 
a purgative dose of castor oil (1 to 2 teaspoonfuls [4.0-8.0] to a child 
of two years), with 20 minims (1.3) of paregoric, should be used 
to sweep out the offending materials and allay irritation, and be fol- 
lowed at once by the treatment which will be spoken of later. 
Care, of course, should be taken to maintain the bodily heat, or lower 
it if it is much above the normal, and a watch must be kept upon the 
pulse and breathing to note any changes requiring stimulants. 

There is still another class of cases. The physician will be called 
to see a child with the same history of having taken indigestible food 
or of there being curds in the stools. Careful examination will show 
that there is much bearing down, or in other cases a simple running off 
of the liquid from the bow T el almost without effort. Very soon, indeed, 
the passages become entirely colorless, except for a speck or two of 
green, which shows the presence of the peculiar micro-organism which 
produces this color. The diapers have a peculiar mousy odor, and 
are characteristic — that is, they seem to be only wet and musty, 
and contain no solid matter. If closely examined, they will be seen 
to be soiled by a small amount of a whitish substance, looking like a 
paste made of water and fine chalk. Such a passage bodes ill for the 
child unless treatment is instituted. The physician should order, at 
once, -^j- grain (0.003) of podophyllin for a child of six months, to be 
taken in two doses, half an hour apart, in 20 drops of brandy with a 
little water. Two hours after this the dose should be repeated, and 
again in two hours more if necessary. By the end of the fourth hour 
there will be generally seen in the movements of the bowels a trace of 
color, and this will gradually become more marked if the case is to 
have a favorable termination. Calomel may be used instead of podo- 
phyllin. 

As soon as the movements have changed from the pasty-white 
motions named to those having a bilious color, then, and not till then, 
are astringents to be employed. If they are used before this, the 
diarrhoea may become less for a few hours, but the child absorbs 
poisons from its alimentary canal and rapidly goes into collapse. 

The rationale of this treatment rests upon the fact that owing to the 



604 . DISEASES. 

disease every gland connected with the alimentary canal has become 
inactive. It is absolutely necessary to bring about glandular activity, 
and podophyllin, in the experience of the author, is the best remedy 
for this purpose. During the period that the podophyllin is acting it 
is well to apply a spice plaster to the belly or to immerse the child for 
short intervals in a hot bath to maintain its bodily temperature. 

In practically every case of cholera infantum it is of the utmost 
importance to stop milk-feeding absolutely for a few days. Nothing 
in the way of food may be given except Valentine's Beef Juice, 10 
minims (0.60) every two hours with a little cold water, or beef- juice 
expressed from rare rump steak, until curds and undigested food are 
no longer found in the stools. 

After these measures have been resorted to, and the chief object — 
namely, a bilious stool — obtained, the diarrhoea must be stopped grad- 
ually. The medicinal treatment should consist in the use of a mixture 
such as the following for a child of a year or eighteen months : 

1^ — Acid, sulph. aromat gtt. xxx (2.0). 

Tr. opii camphorat f 3hj (12.0). 

Elixir. curacoss . . . . . . . f3ij (8.0). 

Aquae cinnamomi q. s. ad f 5iij (90.0). — M. 

S. — Teaspoonful (4.0) in a little water every two hours. 
Or, 

1$ — Acid, sulph. aromat gtt. xxx (2.0). 

01. caryophylli fflviij (0.5). 

Tr. opii camphorat. f 5j (4.0). 

Spirit, chloroformi gtt. xlviij (3.2). 

Syr. zingiberis q s. ad f §iij (90.0). — M. 

S. — Teaspoonful (4.0) every two hours. 

If preferred, the tincture of kino or compound tincture of gambir 
may be substituted for the oil of cloves or the spirit of chloroform, or, 
again, the fluid extract of hsematoxylon may be taken in the place of 
either of these. (See Cholera Morbus, next page.) 

Where the vomiting is very severe and incessant, the purging pro- 
fuse but free from undigested curds, a rectal injection of starch-water, 
2 ounces (60.0), containing 10 drops (0.60), of laudanum, is to be 
employed, and at the same time J grain (0.01) of gray powder 
(hydrargyrum cum creta) given every hour if the podophyllin is not 
well retained. The gray powder may in turn be substituted by ■£% 
grain (0.005) doses of calomel. Very minute doses of arsenic given 
by means of the following solution are often of service in checking the 
vomiting and purging, and should be resorted to if necessary: 

1$ — Liq. potassii arsenitis gtt. j vel ij (0.05-0.10). 

Aquae cinnamomi f oj (30.0). — M. 

S. — Teaspoonful (4.0) every fifteen minutes until four teaspoonfuls (16.0) are 
taken. 

In some cases the remedies named above only check the diarrhoea for 
the time being, and it returns as soon as they are withdrawn. In such 
a case the following is of value to restore the lost tone of the parts 
involved : 






CHOLERA MORBUS. 605 

1$ — Resinae podophylli gr. | (0.03). 

Liq. potass, arsenit gtt. iij vel vj (0.20-0.40). 

Liquor calcis f o iij (90.0). — M. 

S. — Teaspoonful (4.0) every five hours. Shake well before using. 

Or a powder may be used : 

r| — Resinse podophylli gr. \ (0.015). 

Pulv. ipecac. * gr. j (0.06). 

Sacchar. lact gr. xx (1.3). — M. 

Ft. in chart. No. x. 

S. — One powder every five hours. 

A very important, never-to-be-forgotten measure in cholera infantum 
is the use of counterirritation over the belly by means of a mustard 
plaster (1 part of mustard flour to 4 of wheat flour) or by a spice plaster. 
The plaster should be renewed as often as it cools, and kept on con- 
tinuously if the skin will stand it. (See Counterirritation.) 

A remedial measure carried out with great success in cities in the 
treatment of cholera infantum is the use of irrigation of the bowels, or 
rather washing out of the colon. This is accomplished by the use of 
the solution named in the articles on Cholera and Ehteroclysis. The 
inflow tube should be of soft rubber, like a female catheter. The outflow 
tube should be larger, in order to carry off particles of food or 
flakes of mucus. They may be inserted side by side after being oiled. 
The pressure used should be that of a fountain-syringe raised not 
more than three feet above the buttocks, and the outflow should be 
unobstructed. The irrigation may be resorted to every few hours, 
and continued each time until clear fluid flows away. The solution 
should, of course, not be too cold nor too hot — say 100° F. (See 
article on Diarrhoea.) Hypodermoclysis is to be resorted to for collapse. 

CHOLERA MORBUS. 

This acute, painful, rapidly exhausting disorder arises from exposure 
to cold, the ingestion of poisonous or irritating foods, exposure to 
excessive heat, and a number of similar causes. 

In reality, it may be regarded in one instance as a gastroenteritis, 
and in another as an acute serous diarrhoea associated with much 
pain of a griping, rending character. Nothing compares to counter- 
irritation for the purpose of affording relief. A large mustard or 
capsicum draft should be placed over the abdomen and allowed to 
remain as long as it can be borne. If the patient knows that he 
has taken irritant foods, \ ounce (16.0) of castor oil with 15 to 20 
minims (1.0-1.3) of laudanum added to it, to prevent griping, should be 
employed to sweep out the offending masses before any other remedies 
are used, and be followed by an antidiarrhoea mixture, such as here 
follows : 

Rf— Acid, sulph. aromat f'oij vel f5iv (8.0-16.0). 

Extract, hsematoxvli fluid. . . . f 5ij (8.0). 

Spt. chloroform! ' f oss (16.0). 

Syr. zingiberis q. s. ad f o iij (90.0). — M. 

S. — Dessertspoonful (8.0) every two hours. 



(506 DISEASES. 

If the pain is very severe, the patient should be given morphine (gr. J 
[0.015]) and atropine (gr. -jt~o [0.0004]) hypodermically. (See articles 
on Diarrhoea and Cholera, Asiatic.) 

CHLOROSIS. 

(See Anemia.) 

CHOREA. 

St. Vitus' Dance is a nervous affection, generally occurring in chil- 
dren, yielding to treatment quite readily in some cases, and in others 
remaining persistently severe, and even becoming worse, under the 
physician's care. 

The disease is always to be treated by the removal of all sources of 
reflex irritation, such as worms, a long prepuce if it is irritated by 
retained urine or smegma, or other trouble of this character, and in the 
avoidance of punishment or severe rebuke on the part of the attend- 
ants. This advice is given not because chorea is produced by such 
irritating conditions, but because they tend to impair the nervous 
tone of the patient. Except in that form of the disease closely associ- 
ated with or dependent upon rheumatism, the profession universally 
employ arsenic in one of its forms as a specific remedy. Generally 
Fowler's solution is used, and, unless the parents are intelligent enough 
to drop medicine carefully from a bottle or dropper, the physician 
should order a 3-ounce mixture (90.0) with 60 minims (4.0) of Fowler's 
solution, so that each teaspoonful will contain a little less than 3 
minims of the drug. Very frequently, to be effective, arsenic must 
be used in ascending doses, increased 1 minim (0.05) a day, and in 
consequence the dilution just spoken of is to be avoided, and the 
importance of care in measuring the pure drug impressed upon the 
patient's relatives. 

Whenever arsenic is used the physician should instruct the attend- 
ants to stop administering the drug if any puffiness under the eyes is 
seen in the morning on arising from bed, or if any pain in the bowels 
ensues, as these symptoms show that the full medicinal action of the 
drug is being felt. 

When arsenic fails, cimicifuga in the dose of 20 to 30 minims (1.3-2.0) 
of a fresh fluid extract for a child of ten years may be used as the next 
best remedy. 

Where the disease is associated with rheumatism, recent or remote, 
the salicylates or iodides may be of value, and should be thoroughly 
tried. 

In some cases of chorea the muscular jerkings are so severe that 
sleep is impossible, and the patient has to be held in bed and the bed- 
covers tied down. These cases will often obtain a quiet night by the 
use of the hot pack at bed- time. (See Heat.) The child should be 
placed in a blanket previously dipped in water as hot as can be borne 



COLIC {HEPATIC). 607 

by the patient and thoroughly wrapped up in another (dry) blanket to 
retain the heat, and then be allowed to sweat. Care must be taken 
that a heat-stroke does not result, and, if sweating does not come on 
and oppression ensues, the blanket must be removed. The sheets 
should be ironed to have them warmed for the patient when she is 
returned to bed, and it is often better to let her sleep between dry 
blankets. The efficacy of this treatment is increased by the use of a 
dose of bromide of sodium or potassium and a little chloral, as follows; 

1^— Chlorali hydrati 5j (4.0). 

Sodii bromid 3 ij (8.0). 

Aquae dest q. s. adfoiij (90.0). — M. 

S. — A dessertspoonful (8.0) in water every five hours for three doses. 

COLIC (HEPATIC). 

This exceedingly painful condition, due to the passage of a gall- 
stone through the bile-duct, is always associated with faintness and 
nausea. 

The object of the physician must be to relieve this pain, not only 
by the use of anodynes, but also by aiding in the escape of the stone 
into the bowel. To relieve the pain a hypodermic injection of mor- 
phine \ to \ grain (0.015-0.03), accompanied by t Jq grain (0.0006) 
of atropine, is indicated. The morphine not only decreases the pain, 
but allays spasm, and the atropine relaxes the spasm of the muscular 
coats of the ducts and allows the stone to pass through the relaxed 
passage-way. Hot applications, such as turpentine stupes, may be 
used over the liver, but relaxation is not to be obtained by the use 
of nauseating emetics, as the retching or vomiting may rupture the 
distended gall-bladder. Energetic rubbing should not be used for 
the same reason. 

Quite recently the use of olive or cotton-seed oil has been largely 
resorted to in this affection, and while we are not sure of the manner in 
winch it acts, the studies of Rosenberg and others point to the chang- 
ing of the oil into glycerin and fatty acids, the first of which liquefies 
and increases the flow of bile. Often the large dose of oil causes 
nausea, and this, by producing general relaxation, may aid in the 
escape of the stone. The oil is used during the attack of pain, and 
must be swallowed in the dose of half a pint at least ; smaller quantities 
do not suffice. Its action may be aided and its retention in the stomach 
promoted by the addition of a drachm of ether to each dose. 

Shortly after the oil is swallowed sudden relief often occurs, due to 
the escape of the stone into the bowel. The stools should then be 
carefully watched for gallstones, but care should be taken that the 
lumps of soap wmich are passed, made from the oil by the alkaline 
juices in the intestines, are not mistaken for true biliary calculi. If 
the pain does not yield to morphine, chloroform or ether may be 
inhaled for the relaxation of the spasm and the relief of pain. 

In the endeavor to render our treatment of a patient with gallstones 



608 DISEASES. 

rational, we naturally study the causes which induce their formation 
and the manner in which we can expel those stones which have 
formed before the case has come under proper care, or in spite of any 
preventive measures which we may have attempted. Unfortunately, 
we are met at the very beginning of our study by the fact that the 
physiologist and the pathologist have not as yet discovered the exact 
characteristics of the general systemic conditions which underlie their 
formation; but, on the other hand, experimental and clinical studies 
have developed a number of facts which are of great value. Thus, 
we now know that there are a number of local causes which distinctly 
predispose to the formation of gallstone, and that these causes are 
commonly found in that very class in which the systemic tendency to 
stone-formation is most marked. In the first place, a catarrhal state 
of the biliary passages favors the formation of gallstone by providing 
an excess of mucin, with the aid of which the stone maybe formed; 
secondly, this catarrhal state is commonly associated with, or produces 
of itself, a diminished alkalinity of the bile, whereby the cholesterin 
becomes more readily precipitated, and at the same time, it would 
appear, causes the deposition of an abnormal amount of lime salts, 
brought from elsewhere in the body and passed out through the mucous 
membrane. This latter fact seems proved by the circumstance that 
bile itself contains very little lime, and that more lime is found in 
stones lying against markedly catarrhal mucous membranes than in 
stones not so situated. Again, it sometimes happens that the nidus 
for a stone consists of agglutinated typhoid bacilli in the gall-bladder 
or duct. So far, then, we have a simple, pathological process pro- 
viding no less than three ingredients of stone-formation — namely, 
mucin, cholesterin, and stearate or some other salt of lime. There 
are still two other important factors at work — namely, the systemic 
state, gouty or otherwise, which tends to stone-formation, and the 
stasis of the bile in its ducts, because the catarrhal process in the 
mucous membrane blocks its passage toward the bowel. 

Recognizing these etiological factors, it now becomes our duty to 
oppose them, and we have the following indications to fulfil: 1. By 
causing a free secretion of bile to produce a rapid flow of fluid which 
shall be normally liquid and probably normal in its constituents. 
2. By the use of alkalies to antagonize the development of acid ten- 
dencies and to aid in the solution of mucus. 3. By regulating the diet 
prevent those hepatic and systemic disorders which tend to the forma- 
tion of stone. 4. As catarrhal states are often due to or aided by bac- 
terial infection, to produce intestinal asepsis as far as possible. 

The normal secretion and flow of bile are best brought about by exer- 
cise of a gentle and wisely directed nature, taken continually and 
regularly, and particularly those forms of exercise which call into play 
the abdominal muscles and diaphragm or cause hepatic movements. 
The chief and best of these is horseback riding, or, if the patient is 
too feeble for this, massage should be resorted to, the hypochondrium 



COLIC {HEPATIC). 609 

being well but gently kneaded and rubbed daily for a considerable 
period of time. If the liver seems very torpid, calomel in small divided 
doses of a fraction of a grain may be given several times a week, or 
nitromuriatic acid may be more rarely used. In other instances, 
where there is reason to believe that the flow is sluggish and 
the bile not sufficiently alkaline, that catarrh and putrefactive ten- 
dencies are present, the administration of benzoate or salicylate of 
sodium, in 10- or 20-grain doses, will result in increasing the flow, 
increasing the alkalinity, overcoming the catarrh, and then arresting 
intestinal putrefaction. If the catarrhal process is very marked, 
chloride of ammonium will act even more satisfactorily. This treat- 
ment seems especially valuable when the stones that are passed are 
very dark in color, indicating that much pigment and little cholesterin 
is present. In respect to the use of alkalies, the patient should drink 
freely of those mineral waters which will provide alkaline substances, 
such as Contrexeville, Vichy, and Kronenquelle, and it is useful in 
many such cases to relieve any tendency to constipation or duodenal 
catarrh by the administration of hot Carlsbad water before breakfast 
daily. 

In the matter of regulating the diet, all rich or fatty foods are to be 
prohibited. Meat should be used in moderation, preferably white 
meats, and green vegetables largely eaten. 

The catarrhal condition, associated with marked bacterial infection, 
as may be evidenced by some febrile movement, is best controlled by 
the use of turpentine, chloroform, and ether, given internally, and 
accompanied by the application externally of hot poultices to the 
hepatic area. These poultices may or may not be fortified by mustard, 
and when removed should be replaced by a warm pad to prevent 
chilling of the surface of the body. 

Of the internal remedies just named, turpentine is the most useful, 
since it liquefies mucus, aids the flow of bile, and is thought by some 
physicians to cause expulsion of the stone by stimulating the walls 
of the ducts, and to dissolve the stone. The latter action is impos- 
sible. Nevertheless, its continual use seems to prevent the formation 
of stone. Ralfe states that it is best given as follows: 

R— 01. terebinthinsB Itlv (0.30). 

Syrup, acacise f^ss(16.0). 

Sodii phenolsulphonat gr. xx (1.30). 

Spt. setheris composit. . ■ . . . . Tftxv (1.0). 
Aqua menthse piperitae . . . .q. s. f § j (30.0). — M. 
S. — To be taken twice or thrice a day. 

We would prefer adding compound spirit of lavender instead of pep- 
permint-water. If this mixture cannot be retained by the stomach, the 
turpentine may be given in capsule, and followed by a draught of milk. 

Finally, a most important factor in the prevention of gallstone 
formation in susceptible persons is the avoidance of exposure and wet, 
and, if possible, residence in a sunny climate during winter months. 

39 



610 DISEASES. 



CONJUNCTIVITIS. 

Simple Conjunctivitis, sometimes called catarrhal, acute, or muco- 
purulent ophthalmia, is characterized by congestion of the conjunctiva, 
loss of transparency of the palpebral portion, and some dread of light, 
with a discharge sufficient only to glue the lids in the morning or free 
and mucopurulent. In the milder stages the use of a boric-acid 
lotion (10 grains to the ounce [0.60 : 30.0]) is suitable, and the lids 
should be frequently washed with neutral soap and water; if there 
be much mucopurulent discharge, the lid should be everted and an 
application made of a solution of nitrate of silver (from 2 to 5 grains 
to the ounce [0.12-0.30:30.0]). If the discharge becomes profuse, 
bichloride of mercury, 1 : 10,000 may be employed with advantage 
and the nitrate-of-silver solution increased 10 grains to the ounce 
(0.60-30.0), the excess being neutralized with a solution of salt or 
washed away with tepid water. In place of nitrate of silver pro- 
targol and argyrol are preferable remedies, and may be employed in 
a strength varying from 5 to 20 per cent., according to the severity 
of the symptoms. Much inflammatory reaction in this disease may 
be alleviated by iced compresses. Patients suffering from catarrhal 
conjunctivitis should be protected from tobacco-smoke, bright light, 
dust, or any mechanical irritant. Atropine usually is unnecessary 
unless a corneal ulcer complicates the affection. The patient may 
wear smoked glasses, but under no circumstances must the eyes be 
bandaged or have poultices applied to them. Domestic medication of 
this sort may change a simple ophthalmia into a serious and purulent 
inflammation. Topical medications other than those mentioned are 
biborate of sodium (gr. iv-viij to the ounce), alum (4 to 8 grains to the 
ounce [0.25-0.5:30.0]), sulphate of zinc (1 to 2 grains to the ounce 
[0.06-0.12:30.0]), which maybe suitably combined with boric acid 
solution or peroxide of hydrogen. During the subsidence of the 
inflammation, and if it shows any tendency to become chronic, the 
application of an alum crystal or a solution of tannin and glycerin 
(10 grains to the ounce [0.60: 30.0]) is suitable. It should be remem- 
bered that mucopurulent conjunctivitis may become epidemic in 
crowded institutions, and great care should be taken to isolate cases. 
One soiled towel may be the source of infection to a great number of 
children. Constitutional treatment ordinarily is not required, but 
proper hygiene, fresh air, good food, the intelligent use of laxatives, 
and tonic doses of quinine are useful. Conjunctivitis may be associ- 
ated with nasal catarrh, bronchitis, a general cold, eczema of the face, 
and the exanthemata. 

Acute contagious conjunctivitis, vulgarly known as "pink eye," 
does not greatly differ in its manifestations from ordinary simple con- 
junctivitis, except that it is more violent and is more apt to be associ- 
ated with hemorrhages beneath the conjunctiva. As its name indicates, 
it is highly contagious, and sometimes appears in an epidemic form. 



CONJUNCTIVITIS. 611 

It is due, in the great majority of instances, to the Koch- Weeks bacillus. 
A very similar form of epidemic conjunctivitis is caused by the pneu- 
mococcus. The treatment is the same as that already described. A 
solution of sulphate of zinc, 1 or 2 grains to the ounce, is particularly 
efficacious. 

Burns of the Conjunctiva. — Immediately after the accident all 
foreign particles should be removed; then a few drops of cod-liver oil 
may be instilled and atropine employed (suitably incorporated with 
liquid vaselin) to prevent iritis. The chief danger lies in the forma- 
tion of severe corneal inflammation and symblepharon ; the latter 
may sometimes be prevented by daily breaking up the granulation- 
tissue or by the insertion of a piece of goldbeaters' skin between the 
inner surface of the lids and the eyeball. The associated conjunctivitis 
and keratitis require treatment differing in no way from that described 
in connection with idiopathic forms of these affections. 

Purulent Conjunctivitis, which is commonly seen in the adult in 
the form of gonorrheal ophthalmia and in the infant as ophthalmia 
neonatorum, is produced in both varieties by the introduction into the 
eye of a specific virus from either the urethra or the vagina. The 
chief danger of the disorder is destruction of the vitality of the cornea 
and loss of sight. The most important indication is to prevent this 
danger by reducing the amount of swelling of the lids and conjunctiva 
and the profuse discharge, which are the characteristics of the disease. 
These indications are met best in the following manner: Hourly 
cleansing of the eyes with an antiseptic solution, preferably bichloride 
of mercury (1 : 8000) or a saturated solution of boric acid. During 
the acute inflammatory stage, and before the discharge is profuse, 
astringents and cauterants must not be applied. When this stage has 
arrived and the conjunctiva is profusely covered with discharge, the 
lids should be carefully everted once a day, wiped clean of every par- 
ticle of pus, and carefully touched with a solution of nitrate of silver 
(10 to 20 grains tothe ounce [0.60-1.30: 30.01), and the excess neutral- 
ized with a few drops of a solution of common table salt. 'In place of 
the nitrate of silver treatment in recent times protargol and argyrol 
have found much favor. The best method is, after each irrigation of the 
eye, to instil a few drops of the protargol solution (20 per cent.) or 
of the argyrol solution (25 per cent.) in the conjunctival sac, rather 
than to diffuse itself over the entire mucous membrane and to remain 
in contact with it. In the early stages iced compresses frequently 
changed will help to reduce the reaction, or these compresses may 
be made by placing squares of lint upon a block of ice and thus 
securing intense cold. If the vitality of the cornea is threatened, it is 
advisable, in many instances, to substitute for the cold applications 
compresses at a temperature of 110° F. These may be applied 
for from ten to twenty minutes every two or four hours, according 
to the exigencies of the case. The appearance of ulceration in the 
cornea calls for the use of atropine. In adults high reaction and 



612 DISEASES. 

violent inflammation may be alleviated by the use of leeches to the 
temple. Bleeding of any sort is not applicable to newborn infants. 
Other applications which have met with favor are: alum (grains 4-8 
to the ounce), sulphate of zinc (grains 2 to the fluidounce), aqua 
chlori, cyanuret of mercury (1:1500), permanganate of potassium 
(1:2000) employed in copious irrigations, formaldehyde (1:3000), 
argentamin (1 : 5000), and protargol (4-5 per cent, solution, applied to 
the everted mucous membrane, or a 0.25 to 0.5 per cent, solution used as 
a collyrium). The preventive method of treating ophthalmia neona- 
torum that has yielded the happiest results is that instituted by 
Crede — namely, the dropping of a 2 per cent, solution of nitrate of 
silver into the eyes of the newborn infant. This method should be 
employed in all infected cases, and in cases from which the suspicion of 
infection has not been removed; but it is unnecessarily severe if pre- 
vious examination has demonstrated the entire absence of infection. 
Under the last-named condition careful cleansing of the lids of the eye 
and flushing of the conjunctival sac with a mild antiseptic lotion are 
usually sufficient. If it is desired to employ nitrate of silver, 1 : 500 is the 
strength. There is much evidence to show that protargol and argyrol 
are useful under these circumstances. If one eye alone is attacked, 
the other should be protected by covering it with a Buller shield, which 
consists of a watch-glass fixed in a square of plaster, which is applied 
so that the crystal comes directly in front of the eye, and the plaster 
covers the surrounding area. 

Chronic Conjunctivitis may result from an antecedent acute inflam- 
mation of the conjunctiva or exist as an idiopathic affection, especially 
in elderly people, in whom it sometimes becomes a troublesome symp- 
tom, especially if complicating cataract. The characteristic lesions 
are roughness of the papillae of the conjunctiva, swelling of the caruncle, 
and soreness of the angles of the eyelids. There are no granulations, 
although the disease is sometimes inaccurately spoken of as granular 
lids. A soothing wash is indicated (10 grains of boric acid to the 
ounce [0.60: 30.0] of water), to which may be added 2 grains (0.12) of 
cocaine, provided the cornea is not ulcerated, and for which a similar 
boric-acid lotion with 4 grains (0.25) of salt to the ounce (30.0) may 
be substituted. A very suitable local application is lapis divinus (sul- 
phate of copper 1 part, alum 1 part, nitrate of potassium 1 part, fused 
together, and camphor equal to one-fiftieth of the whole added; the 
mass is run into sticks, and the application made to the everted lids, 
or 1 grain (0.06) of the same preparation to the ounce (30.0) of water 
may be dropped into the eye). Other useful applications are tannin 
and glycerin (10 grains to the ounce [0.60:30.0]), yellow oxide of 
mercury salve, and alum crystal. If refractive error exist, this should 
be corrected. It is to be remembered that chronic conjunctivitis dis- 
tinctly contraindicates any operative interference in the eye, as, for 
instance, cataract extraction. There is an interesting form of chronic 
conjunctivitis, or, perhaps, more accurately, subacute conjunctivitis, 



CONJUNCTIVITIS. 613 

which runs a course lasting from eight weeks to several months, and 
which is characterized by very slight objective symptoms, that is due to 
the presence of the diplohacillus of Morax and Axenfeld, and which is 
promptly cured by the application of a solution of sulphate of zinc, 1 or 
2 grains to the ounce. The conjunctival secretion of stubborn cases 
of conjunctivitis should always be examined for this bacillus. 

Lachrymal Conjunctivitis is a name given to a chronic form of 
inflammation of the conjunctiva associated with obstruction in the 
lachrymal duct, and characterized by a tear-soaked appearance of the 
eye, small pustules at the roots of the lashes, and a gummy discharge 
along the palpebral margin. This can be cured only by relief of the 
stricture of the nasal duct which causes it, but may be alleviated with 
the same remedies recommended in the treatment of chronic con- 
junctivitis. Good results are reported from the use of pyoktanin. 

Follicular Conjunctivitis — a disease sometimes mistaken for granu- 
lar lids, but having a distinct clinical difference, inasmuch as the 
swollen follicles are absorbed without the production of cicatricial 
changes in the conjunctiva — requires for its local treatment weak 
astringents and antiseptic lotions, and the application to the swollen 
follicles of an ointment of sulphate of copper (gr. \ to the drachm 
[0.03 : 4.0]), dusting in calomel either alone or with equal parts of 
subnitrate of bismuth, or iodoform or aristol used in the same way. 
If the disease is stubborn, the swollen follicles should be crushed with 
forceps. 

This disease, or one analogous to it, is sometimes produced by the 
prolonged instillation of atropine, and less frequently by eserine and 
cocaine. If this is its cause, the drug must be suspended and the 
surface painted with an alum crystal. 

Granular Conjunctivitis. — This disease may be divided into acute 
and chronic granulations. In the former astringents and caustics are 
inadvisable, the eyes requiring weak antiseptic solutions like boric 
or salicylic acid and the instillation of atropine. Leeches to the 
temple will aid in reducing the inflammatory reaction. In the chronic 
disease the object of treatment is to bring about absorption of the 
granulations which are its characteristic lesion, not by an application 
so caustic as to destroy the mucous membrane around them, but of 
sufficient vigor to produce healthy reaction. The following applica- 
tions comprise those which have been employed with the greatest 
success: 10-grain (0.60) solution of nitrate of silver, if there is dis- 
charge, applied once a day with neutralization of the excess ; sulphate 
of copper in the form of a crystal, carefully applied to the everted 
lids and the retrotarsal folds; glycerole of tannin (tannic acid 30 grains 
[2.0], glycerin 1 ounce [30.0]), best applied with a cotton applicator; 
boroglyceride from 20 to 50 per cent, according to the vigor of the 
granulations. Strong solutions of corrosive sublimate are employed 
in the following manner : Solutions of the strength of 1 : 300 or 1 : 500 
are painted on the everted lids every second day, the pain of the appli- 



614 DISEASES. 

cation being alleviated by the previous instillation of cocaine, while 
three times daily the eyes are irrigated thoroughly with a solution of 
the mercury salt, 1 : 7000. Among the many other applications which 
may be used in this disease the following may be mentioned: liquor 
potassa, beta-naphthol, iodoform or aristol in powder or salve, an oint- 
ment of the yellow oxide of mercury, calomel, and hydrastin. The 
surgical means which are employed to destroy the granulations are 
scarification of the conjunctiva, an inadvisable method; excision of the 
granulations, useful if these exist in isolated groups; crushing the 
granulations with specially devised forceps, a method often followed 
by satisfactory results; scarification, followed by a vigorous brushing 
of the affected tissue with a brush containing short bristles, previously 
dipped in a strong (1 : 500) solution of corrosive sublimate (Grattage); 
electrolysis; and excision of the fornix conjunctivae. In long-standing 
cases associated with inveterate pannus de Wecker has proposed the 
use of an infusion of jequirity (3 per cent.). This produces an intense 
membranous conjunctivitis, which must be treated by iced compresses 
or similar measures to reduce its reaction, but when it has subsided 
the pannus is often relieved. This method has not been employed in 
recent times to the extent that it was practised when first introduced, 
but jequiritol has been tried with reported success. 

Diphtheritic Conjunctivitis is rare in this country, but on the con- 
tinent of Europe occasionally occurs as an epidemic. It may appear 
alone or in association with diphtheria of the throat and nose. The 
initial subjective symptoms are those of purulent ophthalmia; the 
characteristic objective symptoms, a board-like infiltration of the lids 
with a deposit of gray membrane upon the palpebral conjunctiva. 
More than in any other eye disease destructive inflammation of the 
cornea is threatened. In the early stages the eye should be frequently 
cleansed with boric acid or bichloride of mercury solutions, and atro- 
pine instilled, while hot compresses help to maintain the nutrition of 
the cornea more perfectly than the cold compresses which were for- 
merly recommended for antiphlogistic purposes. The constitutional 
measures for diphtheria are necessary, and the best treatment is the 
employment of injections of diphtheria antitoxin. 

Chemosis of the Conjunctiva, in which this membrane is infiltrated 
with serum, is usually a symptom of other ocular disorders, and sub- 
sides under the general treatment directed to their relief. Good results 
may follow nicking the swollen tissues with a pair of scissors, the 
application of a warm, moist compress, and the use of astringents, 
especially alum. 

Hemorrhage beneath the Conjunctiva (subconjunctival ecchymosis) 
may follow an injury, occur during a paroxysm of whooping-cough, 
and occasionally, in elderly people, may appear spontaneously. Recur- 
ring subconjunctival hemorrhages in elderly people are indicative in 
many instances of renal disease, having much the same significance as 
hemorrhages in the retina. No treatment materially hastens absorp- 



CONSTIPATION. 615 

tion of the blood, unless it be massage of the globe through the closed 
lid; any associated conjunctival irritation may call for a boric acid 
and cocaine wash. 

CONSTIPATION. 

This troublesome state depends on a number of causes, the most 
common of which is the following of a sedentary life, totally devoid 
of the exercise intended to keep the intestinal and hepatic secretions 
in an active state. Another frequent cause is simple laziness, which 
causes the patient to resist the call of the bowel for evacuation until 
this part of the body becomes indolent and atonic, while modesty 
often causes constipation in females, because a woman prefers to 
suffer rather than go to a closet which may be somewhat publicly 
situated. In other instances constipation seems to be hereditary, and 
to depend upon deficient nerve-supply or muscular weakness and lack 
of secretion in the lower bowel, or upon hepatic torpor. 

Whatever the causes are, they should be sought for, and, if possible, 
removed, the physician not being content to order purgatives, which, 
while they may give temporary relief, soon lose their power. 

Further than this, it must be remembered that hygienic measures 
always take first place in the method of treatment, and, if possible, 
drugs should occupy a very secondary role. Particular attention 
should be paid to diet, and the physiology of peristalsis must be well 
borne in mind. 

It has been proved by a large number of studies, both in the normal 
intestine and by the use of purgatives, that peristalsis is almost entirely 
a reflex action depending for its existence upon the integrity of the 
nervous plexuses in the intestinal walls — namely, those of Auerbach 
and Meissner — the first of which are situated between the longitudinal 
and circular muscular fibres which they supply, the latter existing 
in the submucosa and supplying the walls of the villi, the glands of 
Lieberkiihn, and the small arteries and venules. 

It has also been found that the vagus nerve, when stimulated reflexly 
or directly, increases peristalsis, and that moderate stimulation of the 
splanchnic nerve decreases it. 1 It at once becomes evident that any 
decrease in the normal activity of these nerves and nerve-centres 
must speedily result in constipation, and the costive condition conse- 
quent upon hepatic torpor is due to the fact that the intestinal walls do 
not receive the proper stimulation from the bile to set in motion a 
reflex peristaltic wave, the result of which will be evacuation. This fact 
rests upon the results of direct experiments, which prove the bile to be 
primarily an intestinal stimulant, antiseptic, and promoter of secretion. 

Other series of experiments have shown that the circulation of the 
blood through the intestines greatly influences peristalsis, and disorders 
in the blood-supply readily bring on intestinal disorder. 

1 Some persons believe that Meissner's plexus receives impulses from the walls of the intestine 
and transmits them to the motor plexus of Auerbach, which then sets in motion peristalsis. 



616 DISEASES. 

The deductions to be drawn from these facts are many. In the 
first place, it is evident that the maintenance of an active, normal 
circulation of blood in the abdomen and a free pouring out of bile 
from the liver and gall-bladder are necessary to a healthy peristalsis; 
and we find that, aside from drugs, there are a number of remedial 
measures which may be resorted to according to the means of the 
patient. By far the best of these is horseback exercise for at least an 
hour a day or every other day, which by the motion actively stirs up 
and excites the abdominal viscera as no other measure can do. If for 
any reason horseback exercise is impossible, then abdominal massage, 
carried out by a capable " rubber, " is to be tried, the hands following 
more particularly the course of the ascending, transverse, and descend- 
ing colon, the kneading movements being also applied to the hypo- 
chondriac regions. If neither of these measures can be used, then 
the patient must resort to those gymnastic movements which involve 
the abdominal muscles, either by the use of dumb-bells or pulleys, 
such as are sold under the name of "home gymnasiums," or by bend- 
ing the body forward, backward, and laterally, with the fists pressed 
into the hypogastrium. 

At the same time that these measures are directed the diet of the 
patient must be so regulated that the food shall contain a large amount 
of residue — that is, after digestion enough of the husk of the grain or 
enough vegetable fibre must be left free in the intestines to form a 
stimulus to the intestinal wall as it slips over the mucous membrane. 
If a meat diet is largely used, so little residue is left after digestion 
that constipation ensues, but if vegetables are largely eaten the reverse 
is the case. No better evidence of this can be adduced than the hard, 
clay-like passages of the dog and the soft passages of the cow. Very 
often a plateful of cracked wheat (wheaten grits) eaten at breakfast 
each morning, or the use of bran bread, will relieve a tendency to chronic 
constipation. In these cases milk as a prominent article of diet is 
to be avoided above all things, since it is almost entirely assimilated 
and leaves no residue, though it supplants other foods. Green or 
canned corn is of great service. Fruits do good in constipation in 
one of two ways — they contain either residual materials or sufficient 
vegetable acid salts to be laxative. Figs, by reason of their many 
small seeds, which scrape the mucous membrane during peristalsis, 
are particularly valuable, and apples, prunes, dates, and tamarinds 
are all useful. It must be remembered that strawberries, raspberries, 
and blackberries are generally constipating rather than purgative. 
In regard to drink, nothing is so good as a glass of cold water taken 
on arising in the morning or just before breakfast, or, if the cold can- 
not be borne, then a glass of as hot water as can be swallowed with 
comfort may be substituted. Coffee is constipating to most persons, 
largely because of its empyreumatic oil, and tea has the same tendency 
because of its tannic acid. Brandy, as every one knows, is distinctly 
constipating, and whiskey possesses so little power to the contrary as 



CONSTIPATION. 617 

to be devoid of influence in either direction. Beers differ in their 
properties, some of them increasing and some of them decreasing 
intestinal activity. 

The patient suffering from constipation should go to stool regularly 
after breakfast every day even if the attempt is abortive, and so train 
the bowel to having a movement at this time. 

The use of drugs for the relief of constipation is capable of division 
into two parts: first, the employment of remedies to unload the bowel, 
which has become filled; second, the use of drugs which will so influ- 
ence the intestines as to cause evacuation and produce normal activity, 
or, in other words, drugs which will cure the tendency instead of 
giving temporary relief. Of the first class we find the various pur- 
gative salts, jalap, colocynth, senna, mercury, castor oil, and rhubarb; 
of the second class, aloes, cascara sagrada, manna, tamarinds, rhamnus 
frangula (buckthorn), phosphate of sodium, and small doses of podo- 
phyllin. The physician should bear in mind that defecation is a nor- 
mal physiological act which must be continued all through life, and it 
is almost as foolish to stimulate the bowel continuously to peristalsis 
as perpetually to employ heart stimulants or respiratory excitants. 

Although habitually employed by many persons in daily doses, 
the purgative salts if given in concentrated form are exceedingly 
harmful in such instances, rapidly losing their power and decreasing 
the patient's strength by the abstraction of liquids and salts from the 
blood. They often produce anaemia when constantly used. These 
salines are to be employed simply to unload the bowel when an excess 
of fecal matter has accumulated or when irritant materials are to be 
swept out of the alimentary canal. In some cases of pelvic conges- 
tion associated with constipation magnesium sulphate may be given 
by enema in the proportion of 2 ounces (60.0) of the salt, 1 ounce 
(30.0) of glycerin, and 4 ounces (120.0) of water. In other instances, 
where great plethora exists, a course of Hunyadi water, Friedrichshall 
or Carlsbad waters, which depend chiefly upon magnesium and sodium 
sulphate for their activity, is of service. When used habitually they 
should be diluted with hot water and given half an hour before 
breakfast. The patient should then take some exercise before taking 
food. Jalap, colocynth, and senna are not to be used constantly, as 
they are too active and the reaction from their effects causes consti- 
pation. Rhubarb is commonly used, but is of its class peculiarly 
unfitted to its task. Although it purges, it is distinctly astringent, 
and is therefore constipating afterward. 

Mercury is exceedingly harmful if used continuously as a purge, and 
may be the cause of much ill-health, of decayed teeth, and of digestive 
troubles. Castor oil is notorious for its tendency to cause ultimate 
constipation. 

Of the curative class of laxatives none compares to cascara sagrada, 
particularly in the form of the aromatic fluid extract or cascara cordial. 
Originally this drug, as prepared, was very bitter, but it is now made 



618 DISEASES. 

almost tasteless by certain manufacturers. This is the only drug 
which alone moves the bowels and at the same time tends to make 
future passages more easy and regular; the dose is 10 to 40 minims 
(0.60-2.60) of the fluid extract or 1 to 6 drachms (4.0-24.0) of the 
cordial. There is almost no griping produced by it. For the regula- 
tion of the bowels of young children, particularly if the case have a 
tendency to rickets, phosphate of sodium in the dose of 5 to 10 grains 
(0.30-0.60) in milk is a useful laxative, and the same salt may be used 
in 30- to 60-grain (2.0-4.0) doses in adults. Manna is to be classed 
as a laxative, but even it sometimes makes the intestinal torpidity 
ultimately much worse. The two remaining drugs of this class, aloes 
and podophyllin, should always be used in combination with other 
non-purgative drugs, as is seen in the following formulae : 

K— Aloes gr. xx velxl (1.3-2.6). 

Extract, nucis vomicae gr. iv (0.25) 

Extradt. physostig gr. iij (0.20). 

Extract, belladonna? gr. iv (0.25). — M. 

Ft. in pil. No. xx. 

S. — One pill at night or night and morning. 

Or, 

Be — Resinse podophylli gr. ij vel iv (0.12-0.25). 

Extradt. nucis vomicae gr. iv (0.25). 

Extract, physostigmatis gr. iij (0.20) 

Extract, belladonna gr. iv (0.25). — M. 

Ft. in pil. No. xx. 

S. — One pill night and morning. 

The object of using several of these drugs is seen at a glance. We 
have already learned that nearly all purgatives tend to produce griping. 
The nux vomica acts as a bitter tonic and stimulant, and prevents 
subsequent atony of the mucous membrane, as well as increases reflex 
action, and consequently improves peristalsis; the physostigma is a 
tonic to the unstriped muscular fibre and gives it strength; the bella- 
donna aids peristalsis by depressing the inhibitory fibres of the splanch- 
nic nerves, by allaying spasm, and by decreasing griping. In using 
these drugs, aloes and podophyllin, it should be remembered that aloes 
is slow and acts particularly on the lower bowel, and that podophyllin 
acts chiefly on the upper bowel and is the slowest in the list of purges. 

In obstinate constipation we are sometimes forced to resort to the 
compound cathartic pill of the U. S. P., or its modified form known as 
the Pilula cathartica vegetabilis (see Colocynth). After the bowels 
have been well emptied by this pill we can often regulate them by 
cascara sagrada with or without other laxatives, and by prescribing 
a proper diet and exercise. 

In the flatulence of old persons associated with constipation a little 
asafcetida or capsicum should be added to the pill of aloes just named. 

In some instances constipation arises from reflex irritation or from 
ovarian or bladder trouble or from chronic lead poisoning. This 
form of constipation may resist all purgatives and yield to opium or to 



COBYZA {ACUTE). 619 

tobacco, which quiets reflex action. Tobacco depresses the inhibitory 
nerves of the gut, and devotees of the " weed" often smoke it for its 
laxative effect. 

The employment of enemata as a routine practice is to be discour- 
aged. In cases where it is necessary to use them for temporary relief 
and to get rid of flatulence, a little soap, common salt, or a few drops 
of turpentine may be added to the water. The injection of glycerin 
(1 to 2 ounces [30.0-60.0]) has been largely resorted to, either pure 
or diluted one-half, and this method has been improved upon by the 
use of glycerin suppositories containing many drops of the drug. 
Glycerin acts in these cases as an irritant to the mucous membrane, 
and causes secretion by this means and by its abstraction of water 
from the tissues by reason of its hygroscopic powers. It is capable, 
however, of causing a good deal of rectal irritation in some persons. 

CORNS. 

These troublesome formations are best treated by the use of sali- 
cylic acid, the following formula being applied night and morning for 
several days, after which the part should be well soaked in hot water, 
when the entire corn will readily come away, but in some cases several 
attempts will be necessary: 

1^ — Acid, salicylic gr. xxx (2.0). 

Extract, cannab. indicse gr. x (0.60). 

Collodii f gss (16.0).— M. 

S. — Apply with a camel's-hair brush. 

The same acid may be used in alcohol, and lactic acid in the same 
proportion is often of service. 

In the so-called "soft corns," with much inflammation, the foot 
should be washed and dried, and a saturated solution of nitrate of 
silver, 60 grains (4.0) to 2 drachms (8.0) applied to the part every 
four or five days. 

CORYZA (ACUTE). 

The treatment of coryza of the acute variety, the form which most 
frequently presents itself to the physician for relief, is followed in many 
instances by such marked amelioration of the symptoms and shorten- 
ing of the attack as to encourage medical interference. It must be 
remembered, however, that the duration of the condition before the 
patient presents himself has much to do with the prognosis, for if the 
tissues of the nasal chambers have become boggy and swollen with 
exudate recovery must be more delayed than if remedies are applied 
in the early stages of the catarrhal process. The local treatment con- 
sists in the following measures for relief: By means of a medicine- 
dropper or an atomizer a few minims of a 4 per cent, solution of cocaine 
are dropped into the nostrils, the patient's head being well tipped back. 
If there is any contraindication to cocaine, adrenalin 1 : 10,000 may 



620 DISEASES. 

be used in many cases. After the constringing influence of the 
cocaine has shrunken the congested mucous membrane, so that 
the patient can draw air through the nostrils, the nasal chambers 
should be washed clean of mucus by means of the following lotion 
in an atomizer: 

1$ — Sodii chloridi gr. xv (1.0). 

Acid, boric gr. x (0.60). 

Sodii borat gr. x (0.60). 

Aqiuedest f^iij (90.0).— M. 

The parts being thoroughly cleansed, a fine spray of the following 
should be used as antiseptic, sedative, anaesthetic, and protective: 

1$ — Menthol gr. viij (0.5). 

Camphor gr. v (0.3). 

Albolene f 5j (30.0).— M. 

In this prescription the menthol exerts an anaesthetic effect, and pro- 
longs the constriction of the parts produced by the cocaine, so avoiding 
the secondary capillary dilatation due to that drug. The camphor 
exercises its well-known soothing influence, and the albolene protects 
the membrane from dust and irritants. It is well to use a solution of 
antipyrin 2 to 4 grains to the ounce (0.12-0.25 : 30.0) of water as a 
spray to prolong the effect of the cocaine. The albolene spray 
should follow, not precede, the antipyrin, as the oil would prevent 
the antipyrin from acting. Under no circumstances should the 
antipyrin be used without the cocaine preceding it, as the pain is 
too severe. 

The internal treatment consists, in the very beginning of the attack, 
of the use of the formula for this purpose composed of belladonna, 
camphor, and quinine, and recommended in the article on Camphor. 
Much benefit often follows the use of 30-grain doses (2.0) of sodium 
bicarbonate every two hours for three doses. A hot foot-bath, with 
mustard in it, and the taking of a hot drink, such as lemonade 
with whiskey in it, on going to bed, are useful. Often 20 or 30 
minims (1.3-2.0) of sweet spirit of nitre added to this drink will 
increase its diaphoretic effect. In other cases, particularly in strong, 
hearty men, 5 to 10 grains (0.3-0.60) of Dover's powder at bed-time 
will be better. 

This line of treatment is of little value after secretion has been fairly 
established, and in its place supportive measures are indicated. Small 
tonic doses of quinine, 2 to 4 grains (0.12-0.25) three times daily, some- 
times combined with the use of 5 to 10 grains (0.3-0.60) of chloride 
of ammonium, as prescribed in the article on Bronchitis, are useful. 
Where much headache is present full doses of the bromide of potas- 
sium or sodium are to be given, and the spray treatment already 
named for the purpose of cleansing the nasal chambers is to be per- 
sisted in while the attack lasts, but the cocaine ought not to be 
employed at this time unless absolutely needed. (See Camphor.) 



CYSTITIS {ACUTE). 621 

CROUP. 

(See Diphtheria.) 

CROUP (SPASMODIC). 

As this is a spasm of the glottis depending for its causation upon 
catarrh of the mucous membrane of the larynx, and as it is due most 
commonly to some reflex irritation, such as dentition, indigestible 
food, or sudden atmospheric changes, or to rhachitis, or to the presence 
of postnasal adenoids, the treatment is both prophylactic and curative. 
Prophylaxis consists in the avoidance of cold; the use of a simple diet, 
particularly at the evening meal ; the rendering of the air of the bed- 
room moist by means of steam, or at least by the avoidance of dust- 
laden, furnace-heated air, and by the removal of dental irritation and 
nasal hypertrophies, which make the child a " mouth-breather." 
Iron and arsenic are useful tonics if the child is anaemic and rachitic. 
Much relief can be provided such patients by having them sleep in a 
"bronchitis tent." (See article on Bronchitis.) Small doses of the 
bromides, chloral, belladonna, or opium may be resorted to at bed- 
time. A very useful prescription for this purpose is that which follows : 

P^— Sodii bromidi 3j (4.0). 

Syrupi lactucarii fgij (60.0).— M. 

S. — Teaspoonful to a dessertspoonful (4.0-8.0) on going to bed, and once 
or twice during the night if needed. 

When the attack is present, a cold cloth should be wrapped about 
the neck and the child placed at once in a hot bath, the air of the 
room being moistened by the steam escaping from a kettle of boiling 
water or by pouring water upon unslaked lime. If the paroxysm is 
very severe, a few whiffs of amyl nitrite may be employed. It is also 
useful to disseminate the fumes of menthol through the air of the room 
by heating some crystals in an iron spoon. If the fumes are strong 
enough to produce a distinct odor, they are present in sufficient amount. 

CYSTITIS (ACUTE). 

If, by reason of exposure to cold, injury, the introduction of foreign 
bodies, such as dirty catheters, or the presence of gonorrhoea or other 
disease due to an infection, an acute inflammation of the bladder 
ensues, it is accompanied by a sensation of weight and vesical fulness, 
by pain, tenesmus, and inability to retain the urine. Sometimes the 
last-named condition may be reversed and retention of urine be 
present. 

If the general system responds to the local inflammation, as evidenced 
by increased arterial excitement and fever, aconite in full doses of the 
tincture should be used, and it should be combined with small amounts 
of sweet spirit of nitre and citrate of potassium, as follows: 



622 DISEASES. -r 

1$ — Tinct. aconiti . f 3 iij (12.0). 

Spirit, aether, nitrosi i'oj (30.0). 

Liquor potassii citratis . . . q. s. ad f§vj (180.0). — M. 
S. — Dessertspoonful (8.0) every four hours until all fever ceases and the pulse 
is quiet. 

At the same time a hot compress should be applied over the bladder, 
but it should not contain turpentine or any irritant substance which 
may be absorbed from the skin and when eliminated by the kidneys 
irritate the bladder-walls. Leeches may be placed upon the perineum 
or cups applied to the region of the sacrum. In some cases belladonna 
may be used with or without aconite in the dose of 5 to 10 minims 
(0.30-0.60) of the tincture three times a day, and it is worthy of note 
that this drug is particularly serviceable in cystitis due to cold. If the 
urine is acid and irritating, 5 minims of liquor potassse every four 
hours, or the citrate or acetate of potassium, may be used. If there 
is much pain and bearing-down, an enema of 30 minims (2.0) of 
deodorized laudanum in 2 ounces (60.0) of starch- water may be 
employed, or the opium may be given in suppository. 

Sometimes a belladonna suppository is of more service, and an 
iodoform suppository will often relieve the pain by its local anaesthetic 
effects. Hot enemata, without any drugs, are often valuable as a 
means of relief, and a hot sitz-bath is very efficacious. Cannabis 
indica, if an active preparation can be had, may be better than opium 
in some cases to relieve the pain, since it seems to aifect the bladder 
favorably. The other curative measures are hygienic, and consist 
in maintenance of the recumbent posture, absolute physical and 
mental rest, avoidance of all foods which are stimulating, as rare 
meats and highly seasoned dishes, and abstinence from all varieties 
of alcoholic beverages. 

Should the inflammation be severe enough to become purulent, the 
physician should order phenyl salicylate in the dose of 10 grains (0.60) 
three times a day. This drug, being broken up in the bowel into 
phenol and salicylic acid, is so eliminated that it renders the urine 
antiseptic; or in other instances, if the urine is alkaline and phos- 
phatic,hexamethylenamine (urotropin or uritone) in the dose of 5 to 10 
grains (0.30-0.60) should be given in capsule after food or drink three 
or four times a day. 

Laxatives are to be employed with persistence if the bowels are 
confined, and saline purgatives in the early stages are generally better 
than vegetable purges. 

Quinine should not be used against the fever, as it is contraindicated, 
owing to its irritant effects upon the bladder. 

CYSTITIS (CHRONIC). 

The treatment of chronic cystitis is entirely different from that of 
the acute form, and consists in the use of remedies which will stim- 
ulate the diseased mucous membrane, cause a normal secretion of 
mucus, and so influence the urine that the mucus already formed will 



* CYSTITIS {CHRONIC). 623 

be passed out and the fluid rendered alkaline or acid, as may be 
desired. When the secretion of mucus in large amount is persistent, 
the urine should be rendered alkaline by the use of liquor potassse or 
the citrate of potassium. The bitartrate of potassium, unlike the other 
vegetable salts of potassium, such as the acetate or bicarbonate, is 
eliminated as the bitartrate of potassium, and, as it is acid, cannot be 
employed. 

We acidify the urine when it is necessary to dissolve the phosphates 
and to prevent deposits in the bladder and elsewhere. The three best 
drugs for this purpose are hexamethylenamine (urotropin or uritone) 
in the dose of 5 grains (0.3) three or four times a day, boric acid in 
the dose of 5 to 10 grains (0.30-0.60), or benzoate of ammonium 10 
to 20 grains (0.60-1.3) three times a day. The rule may be laid down 
that if the urine is high-colored and is strongly acid, alkalies are use- 
fid ; whereas if it is light in color, but loaded with phosphates, urotro- 
pin or uritone should be employed. Hexamethylenamine or urotropin, 
uritone, or phenyl salicylate may be given to prevent decomposition 
of the bladder contents. 

The remaining remedies which are employed internally in chronic 
cystitis are those which are directed to the improvement of the mucous 
membrane of the bladder, and consist of buchu in the form of the 
fluid extract in the dose of h to 1 drachm (2.0-4.0), well diluted; 
arbutin or ursin, 3 to 5 grains (0.20-0.30) ; or the fluid extract of 
uva ursi, dose 30 minims to 1 drachm (2.0-4.0). All of these are 
better fitted for the treatment of subacute than chronic cystitis, as 
they are not sufficiently active for the chronic forms. 

In cystitis of a very chronic type, with great vesical atony, strychnine 
is of service, and drop-doses of tincture of cantharides do great good. 
Turpentine may also be used with advantage in 5- to 20-minim 
(0.3-1.3) doses, as may also the oils of eucalyptus, sandalwood, cubebs, 
and copaiba. 

One of the best measures for the relief of chronic cystitis is to irrigate 
the bladder daily with pure warm water or water containing bichloride 
of mercury in the proportion of 1 : 10,000, as this washes away all 
mucus and uric-acid deposits and prevents irritation. Solutions of 
nitrate of silver have been used with great success where the urine is 
mucopurulent, and Thompson recommends the use of a solution of 
the strength of 1 grain to 4 ounces (0.06 : 120.0) of water, gradually 
increased to 2 grains to the ounce (0.12 : 30.0). Others, such as Gard- 
ner, Richardson, and Potter, recommend the use of stronger solutions, 
5 grains to the ounce (0.30 : 30.0) of water, claiming that while these 
amounts may produce serious effects in some instances, they are very 
efficacious in obstinate cases. The physician should have at hand a 
solution of common salt, which he should inject into the bladder at 
once if the effect of the silver solution is too painful or seems excessive. 
This treatment is suited only to the most chronic cases. 

A weak solution of mercurol and a saturated solution of chloretone 
may also be used with advantage. 



624 DISEASES. 

All these measures are suitable for the treatment of cystitis in the 
male and female, but it is to be noted that injections into the female 
bladder are made much more readily than into that of the male, because 
of the shortness of the female urethra. In either case the operation 
is best performed by attaching a small funnel to a soft-rubber catheter 
and filling the bladder by raising the funnel when full of water above 
the patient's belly. Creolin has been highly recommended by Parvin 
in the strength of from 1 to 2 per cent, with water. The irrigation is 
to be performed every twenty-four hours. 

DIABETES INSIPIDUS. 

Diabetes insipidus is a profuse urinary flow dependent upon some 
disorder of the innervation of the kidney or upon atony or relax- 
ation of this organ. Its treatment consists in the use of astringents 
and tonics, and in some cases in the employment of opium or bella- 
donna, particularly if the oversecretion is due to nervous irritability. 
Gallic acid may be used in 20-grain (1.3) powders three times a day, 
and the fluid extract or wine of ergot is often of service given in the 
dose of 30 minims to a drachm (2.0:4.0) of the former or a wine- 
glassful (30.0) of the latter. As tonics the sulphate of iron and strych- 
nine are indicated. Suprarenal gland may be employed with advantage 
in some cases. 

DIABETES MELLITUS. 

In the treatment of this affection it should be remembered that it 
is the result of disordered function, and is not a disease in itself, but 
a symptom of several disease-processes. For this reason a remedy 
which succeeds in one case may fail in another. 

The treatment of diabetes mellitus is both dietetic and medicinal, 
of which the more important part is the diet since diabetes is a state 
of the body in which the system is unable to utilize properly the carbo- 
hydrate portions of the food, and as a result sugar is passed out in 
the urine. Glycosuria, or the mere presence of glucose in the urine, 
is not diabetes, although if it is constant it may be the early stage of 
the disease. Manifestly, both of these states are to be treated by 
decreasing the intake of those articles which will produce glucose, 
namely, the starches, and therefore the carbohydrates are to be greatly 
cut down in all antidiabetic diet-lists; but changes in the diet should 
be very gradually instituted, since sudden cutting off of certain articles 
may cause marked nutritional disturbance. In a certain number of 
patients it is possible for them to make glucose out of proteid matters, 
and therefore even a total abstinence from starch does not cause the 
sugar to disappear from the urine, for the sugar is then made from meat 
food or from the patient's tissues. This does not occur with fats, and 
for this reason these are important articles to the diabetic. We must 
prescribe fat meats, and, contrary to old teaching, order rich milk 



DIABETES MELLITUS. 625 

instead of skimmed milk. The following articles should be allowed: 1 
Meats of all kinds (except liver), eggs, fish, cheese, butter, and 
cream; oyster-plant, asparagus (?), tomatoes, almonds, pecan nuts, 
butternuts, walnuts, and cocoanuts; string-beans, beet tops, radishes, 
mushrooms, lettuce and water-cress, cauliflower, spinach, and onions. 
Celery and cucumbers may also be permitted. 

Of the foods and drinks to be avoided, we have all forms of sugar, 
all forms of starch, such as ordinary flour, cornmeal, arrowroot, sago, 
tapioca, oatmeal, barley, carrots, beets, parsnips, pie-plant, peas and 
beans, chestnuts, and most of the fresh fruits, cider, beers, champagne, 
sweet wines, and honey. 

A useful artificial milk will be found described in Part III. 

The patient should have a diet so arranged as to give all the calories 
he needs without starch, and this may be accomplished if he takes daily 
2 ounces (60 grammes) of butter, 2 eggs, 2\ drachms (10 grammes) 
of olive oil, 1 ounce (30.0) of fat cheese, 1 quart (960 c,c.) of milk, 
and 1 ounce (30.0) of alcohol. This will give the man 1600 calories 
and he needs but approximately 2400 to 3000, which can be obtained 
by additional food. 

The treatment of diabetes by drugs is varied by the condition of 
the patient, the cause of his disease, and the quantity of sugar in the 
urine. While the drugs most commonly employed are used in 
many instances without any knowledge of how they act, and have 
each of them warm supporters among authorities, much of the treat- 
ment must depend upon whether or not a rheumatic or gouty taint 
is the cause of the trouble, or whether it is due to high living and 
little exercise, producing a plethoric, congested, overloaded system. 
In the first class of cases iodide of potassium and the salicylates will be 
most serviceable; in the second class, a restricted diet, moderate exer- 
cise, and purgation to relieve engorgement of the hepatic and gastric 
veins may be needed. In the cases of gouty diabetes, where relief 
does not follow the use of the iodides and colchicum, resort must be 
had to arsenic and lithium citrate or carbonate, a combination pecu- 
liarly adapted to such a condition according to several authorities. 
Indeed, arsenic is a sheet-anchor with many practitioners in all forms 
of diabetes, and should be given in fairly large, constantly repeated 
doses for a long time. A very much larger body of medical men rely 
on opium or one of its alkaloids, such as morphine or codeine. The 
former is used in the dose of \ to \ grain (0.015-0.3) three times a 
day; the latter, 1 to 5 grains (0.06-0.30) three times a day, and the 
writer has found them very useful. The morphine is by far the most 
powerful for good. Patients who are diabetic must take large ascend- 
ing doses of opiates, which they bear very well. (See article on Opium.) 
The chloride of gold and sodium (y 1 -^ grain [0.006]) has been highly 

1 It is worthy of note that certain persons having a slight glycosuria without serious injury 
waste under a limited diet, and require ordinary fare to support the body plus the diabetic 
drain, 

40 



026 DISEASES. 

recommended by Bartholow, and ergot by Wood and Da Costa. In 
cases depending upon a gouty diathesis the use of salicylic acid is 
often of great value, the dose being 10 to 15 grains (0.60-1.0) three 
times a day. 

In those cases of diabetes in which diet will control the disease the best 
clinicians insist that drugs should be avoided, for when opium or any 
of its alkaloids are used it is necessary to give rapidly increasing 
doses, which finally become enormous, as much as 7 grains (0.45) of 
morphine a day being taken by some persons. Once having begun 
the use of drugs in severe cases, it is very dangerous to stop them, 
for clinical experience has shown that many of these patients waste 
rapidly and generally break down when this is done. In regard to 
the time of day at which to give the morphine or codeine, they are gen- 
erally given about one hour after meals. Under these circumstances 
the drugs seem to decrease diuresis more than if the dose precedes the 
meal; further than this, the stomach is not disordered. In some 
cases results will be obtained from opium when its individual alka- 
loids fail. Careful observation of the patient should be carried out 
to determine the proper beginning and subsequent doses, and if at 
first the opiates fail to give relief discouragement .should not be felt. 

Jambul is a remedy which has been widely used by clinicians for 
the relief of diabetes with such varying results that its position in 
therapeutics is uncertain. This is probably because it is effective in 
one form of diabetes and not in another, and we are unable to make 
the clinical distinction. Jambul is used in powder or the powder is 
placed in capsules or pills. The dose is 5 to 30 grains (0.3-2.0) once 
to thrice daily, and gradually increased. As much as an ounce (30.0) 
has been given in twenty-four hours. This medicament is said to be 
advantageously combined with a pure meat diet in diabetic cases. 

The excessive thirst of diabetes can be best allayed by the use 
of acidulated water or alkaline waters containing non-purgative salts. 
It is useless to cut off the water-supply, to the production of great 
suffering, but the patient should use moderation in drinking so far as 
possible, because the overloading of the stomach tends to disturb 
digestion. 

The wasting coming on in diabetes is to be treated by careful diet, 
rest, and the supply of all the food which the patient can digest. In 
many instances the amount of aliment ingested is extraordinarily 
large, while in others digestion is so impaired that food cannot be 
freely taken. 

If cachexia comes on, iron, strychnine, bitter tonics, and the lacto- 
phosphates of lime and sodium are to be used to support the circulatory 
and nervous systems. Tea and coffee and all forms of food needing 
sweetening may be rendered palatable by the use of saccharin or of 
glycerin. The former passes through the body unchanged; the latter 
increases the glycogen in the liver, but checks the formation of sugar. 

Unfortunately, we have no positive knowledge as to the causes 






DIARBHCEA AND D YSENTER Y. 627 

of diabetes, and in consequence cannot explain the manner in which 
opium, codeine, or other drugs produce relief. 

Diabetic coma is a most dangerous complication of this disease, 
and should be treated as actively as our knowledge of its cause permits. 
It is thought by some that the symptoms are entirely dependent 
upon the presence in the blood of oxybutyric acid, and that hypo- 
dermoclysis or the intravenous injection of normal saline solution 
(7 : 1000) should be resorted to. Stadelman insists upon the employ- 
ment intravenously of 150 c.c. of normal salt solution to which 7.2 
gm. of sodium carbonate and 4.6 gm. of sodium bicarbonate have 
been added. The injection is continued until the urine is alkaline. 
Unfortunately, the statistics of this method of treatment are not good 
so far as permanent recovery is concerned, but some form of transfusion 
should be used. (See Transfusion.) As the condition is a typical 
toxaemia, a full dose of sulphate of magnesium or sulphate of sodium 
should be given, to aid elimination by the bowels if they are loaded 
with feces. Otherwise purgatives should not be used, as they con- 
centrate the blood. Hypodermic injections of ether should be resorted 
to to support the heart. 

In severe cases of diabetes in which coma is feared because of a 
sudden increase of acetone in the urine or in which mild premonitory 
drowsiness is present, bicarbonate of sodium should be given in full 
doses, as much as J to 1 ounce (16.0-30.0) a day. This treatment 
should be instituted whenever the urine gives the characteristic reaction 
for acetone with perchloride of iron. 

DIARRHOEA AND DYSENTERY. 1 

Diarrhoea is a term loosely applied, perfectly correctly, to all forms 
of intestinal disturbance accompanied by the passage of liquid stools, 
and its meaning, "to run through," expresses the state it represents. 

The treatment of each form of diarrhoea depends upon its cause, 
and no case can be intelligently treated in which the physician fails 
to recognize this aspect of the case. Diarrhoea is but a symptom, not 
a disease, and must be regarded solely as an evidence of intestinal 
disorder. 

While the same drugs are prescribed in many forms of the trouble, 
we may divide cases of diarrhoea into four classes, as follows : (a) 
those in which the laxity is due to a catarrh, acute or chronic, of 
the intestinal mucous membrane, causing the passages to contain 
mucus; (b) those in which, owing to disordered innervation, a profuse 
outpouring of liquid takes place from the bloodvessels into the intes- 
tinal lumen; (c) those in which, owing to disease, the glands fail to 
prepare juices to digest the food properly; and finally (d) those cases 
in which ulceration causes irritation and bloody purging. 

1 The articles on Cholera, Cholera Morbus, and Cholera Infantum should be carefully read in 
connection with this article. 



628 DISEASES. 

The treatment of the catarrhal form first named consists primarily 
in regulation of the diet, which should be made up chiefly of milk, 
boiled or predigested, or of milk whey, and in the administration of 
castor oil or other mild purge, such as sulphate of magnesium, to 
sweep out fermenting food and mucus. Enough laudanum should 
accompany this oil to prevent griping, and it is well to add bicarbonate 
of sodium, grains 20 to 30 (1.3-2.0) to the dose, both to aid the action 
of the oil and to render the bowel alkaline in reaction (normal) instead 
of acid, as caused by the fermentation abnormally present. A mustard 
plaster or other counterirritant should be applied to the abdomen. 
Often in the milder forms of mucous diarrhoea this is all that is needed, 
but more frequently it must be followed by the use of tonics and 
astringents, such as nitrate of silver and hyoscyamus, in the following 
pill: 

1$ — Argenti nitratis gr. ij (0.12). 

Extract, hyoscyami gr. v (0.3). — M. 

Ft. in pil. No. x.*^ 

S. — One three times a day. 



Or, 



1$. — Plumbi acetatis gr. ij (0.12). 

Extract, opii gr. ij (0.12).— M. 

Ft. in pil. No. x. 

S. — One three times a day. 



If these stop the diarrhoea, yet there still seems to be a tendency for 
it to return or atony is present, we should use a pill containing the 
extract of chiretta or employ nitromuriatic acid, or, better still, dilute 
nitric acid and compound tincture of cardamoms, because the constant 
tendency to relapse indicates a deficient secretive action on the part 
of the intestinal glands, which these remedies are prone to improve: 

1^— Acid, nitric, dil foj (4.0). 

Tr. cardamomi comp f§ij (60.0). 

Tr. gentian, comp f gij (60.0). — M. 

S. — Dessertspoonful (8.0) every four hours. 

In the second form of diarrhoea named — that in which serous or 
watery purging is present — the treatment is radically different. In 
these cases the bloodvessels of the gut are relaxed and leaking, and 
must be contracted and made water-tight. This dilatation may result 
from fear (" nervous diarrhoea"), from exposure to cold, or from 
exhaustion, extreme heat, and irritant food. If from irritant foods, 
they are generally swept out in the first flush of liquid. 

The measures to be adopted consist in those directed to the con- 
traction of the dilated and relaxed bloodvessels and the restoration 
of the proper nerve-supply to the parts. 

As the splanchnic nerves are the vasomotor nerves of the intestine 
as well as the inhibitory nerves of peristalsis, it is evident that drugs 
must be used which will cause stimulation of these fibres, and the 
chief of these is found to be opium, which diminishes intestinal per- 
istalsis and secretion by just such an influence. In the same way 



DIARRIKEA AND DYSENTERY. 629 

small doses of volatile oils are of service, and camphor and spirit of 
chloroform may be used. As there is relaxation, astringents are indi- 
cated; and as sulphuric acid is not only astringent, but is eliminated 
by the lower bowel, it is peculiarly serviceable. We find, therefore, 
that the following prescription fulfils every indication: 



R — Acid, sulph. aromat. 

Olei cajuputi 
Fluidext. hsematoxyli 
Spt. chloroformi 
Syr. zingiberis 



. . . f3ss(16.0). 
. . . gtt. xl (2.60). 
. . . f^ij (8-0). 
. . . fziv (16.0). 
q. s. ad fgiij (90.0).— M. 



S. — Teaspoonful (4.0) in water every two or three hours. 

If desired, kino or gambir may be used in lieu of the hsematoxylon, 
or the oil of cloves substituted for that of cajuput. Camphor or 
paregoric may also supplant these drugs: 

1$ — Acid, sulph. aromat f ojss (6.0). 

Spt. chloroformi i'oij (8.0). 

Tr. opii camphorat f §ij (60.0). 

Syr. zingiberis q. s. ad f §iv (120.0). — M. 

S. — Dessertspoonful (8.0) in water every two hours. 

Or, 

I$— Tr. kino f 5j (30.0) 

Tr. gambir comp f 5 j (30.0). 

Misturse cretse f oiij (90.0). 

Aquae cinnamomi . . . . q. s. ad f §vj (180.0). — M. 
S. — Shake well before using. Tablespoonful (16.0) every three hours. 

In some instances these attacks appear to depend upon hepatic 
disorder, and the only cure, aside from partial relief, is to be obtained 
by the use of 2 to 6 grains (0.12-0.40) of mercury with chalk (hydrar- 
gyrum cum creta) or calomel, given in \ to \ grain (0.01-0.03) doses 
until 1 or 2 grains (0.06-0.12) have been taken. What is said of 
intestinal disorder from lack of secretion under the heading of Cholera 
Infantum applies very forcibly to these cases, and diarrhoea may persist 
for weeks, or only temporarily be held in check by the most powerful 
drugs, until the physician thoroughly flushes the intestine with bile by 
the use of calomel. 

For the purpose of establishing intestinal antisepsis, phenyl salicy- 
late may be used, and naphthalen, thymol, or other drugs of this class 
may be employed, particularly salicylic acid. In other cases phenol- 
sulphonate of zinc in the dose of from 1 to 4 grains (0.06-0.25) in 
powder or capsule is beneficial. Phenyl salicylate combined with chalk 
mixture may also be advantageously used. (See prescriptions under 
Salol.) Eudoxin, one of the new bismuth salts, is also of value. It 
is doubtful if true intestinal antisepsis can be produced by drugs ; and 
if they can, they probably destroy useful benign organisms as well as 
those which are malignant. 

Wood has highly recommended the use of a bismuth powder con- 
taining a minim or two of phenol. 

The regulation of the diet, which should consist in sterilized milk 



630 DISEASES. 

or koumyss, the former being predigested, is of the greatest impor- 
tance. 

The after-treatment consists in the use of tonics and a carefully 
regulated diet, which should be largely composed of milk and milk 
foods. 

The third class of cases consists chiefly of children who pass fetid, 
"mousy" smelling stools in summer diarrhoea, with green, spinach- 
like masses of semidigested food or distinct lientery. These cases 
may be due to deficient glandular action in any part of the alimentary 
canal, and are often cured by the use of pepsin and hydrochloric acid 
to aid the gastric processes. In other instances the duodenum is at 
fault, and should be stimulated by small doses of nitromuriatic acid ; 
or by podophyllin in the dose of -fo to ■£$ grain (0.0012-0.0015), 
with a little milk-sugar, or given in alcoholic solution. Similarly, 
ipecac in powdered form may be used in the dose of \ to J grain 
(0.015-0.03) three times a day. In the case of children who are 
sufferers from rickets, phosphate of sodium, lime-salts, and common 
salt should be freely given. (See Cholera Infantum.) 

The fourth type, generally known as dysentery, is due in nearly 
all cases to the micro-organism of Shiga, to the drinking of impure 
water, exposure to heat or cold and the use of improper food. It is 
in most cases a very obstinate form of diarrhoea, requiring much skill 
and patience for its cure. 

There are three remedies which are far above all others in value and 
should always be resorted to. The first of these is sulphate of mag- 
nesium with sulphuric acid; the second is calomel; the third ipecac. 

The magnesium salt should be used in a special manner to be 
effective. (See Magnesium Sulphate.) If calomel is used, it must 
be given in full purgative amounts, but is contraindicated if much 
weakness is present. 

The third remedy, ipecac, is never to be forgotten. (See Ipecac- 
uanha.) 

If Flexner's studies are completed, it is probable that an effective 
antidysenteric serum will be discovered. 

If the passages are slimy and bloody, ¥ io" grain (0.0003) of 
bichloride of mercury every hour or two is of service, and if much 
blood is present high rectal injections of hamamelis water and 
water half and half are of value. In some forms of dysentery, 
due to acute inflammation, large enemata of iced water are of the 
greatest value. The water should be ice-cold, and at least a quart 
injected by hydrostatic pressure. This method can only be used in 
strong persons, and is very useful in that it also aids in reducing any 
fever which may be present. The following mixture may be injected 
into the bowel in place of cold water in feeble cases : 

Ifc— Sodii boratis 3j (4.0). 

Tinct. benzoin f oj (4.0). 

Spt. camphorse f oj (30.0). 

Aqua? ferventis Oij (960 c.c.).— M. 



DIAREHCEA (CHRONIC). . 631 

If the ulcers are very old and chronic, nitrate-of-silver injections 
of the strength of 10 to 20 grains (0.60-1.3) to the pint (480 c.c.) of 
water may be employed in large bulk, a salt solution being at hand 
for the precipitation of the silver salt if the local action which ensues 
is too severe. . 

Recently the injection of water or medicaments into the bowel for 
the purpose of influencing the intestinal wall has given way to irri- 
gation by means of an inlet and an outlet tube. The inlet tube should 
be attached to a fountain syringe, and the outlet tube be long enough 
to reach to a vessel by the side of the bed, and of sufficient calibre 
to carry off flaky mucus. In many cases of dysentery of a mild form 
rectal irrigation will suffice, but if the entire colon is involved higher 
injections are necessary. The irrigation should be continued until 
the returning fluid becomes perfectly clear and free from foreign 
particles. If the bowel movements are very frequent, the injections 
may be made every three hours. Probably the best solution to 
employ for irrigation where much mucus and pus is present is one 
of bichloride of mercury, 1 : 5000. When this is used, a pure water 
injection or one of 1 : 30,000 should follow it, in order to prevent 
absorption of too much mercury into the system. If for any reason 
the effect of the bichloride is feared, boric acid may be used in the 
proportion of 1 drachm (4.0) to the pint (480 c.c), or 15 grains (1.0) 
of phenolsulphonate of zinc added to 1 quart (960 c.c.) of hot water 
be injected. If the dysentery is due to the amoeba coli, large rectal 
injections of a solution of quinine in the proportion of 1 : 3000 should 
be used, as this drug destroys that organism. (See Enteroclysis, in 
Part III.) 

Tannic acid is an intestinal antiseptic, and can be employed in 
the strength of 1 drachm to the pint (4.0 : 480 c.c.) for irrigation 
purposes. 

DIARRHOEA (CHRONIC). 1 

This is one of the most obstinate conditions which the physician 
is called upon to treat. It may be due to nervous irritability of the 
bowels, so that the entrance of food or drink sets up an excessive 
peristalsis which so hurries the food and drink through the alimentary 
canal that digestion and absorption are imperfectly performed. Chronic 
diarrhoea may also be due to chronic intestinal catarrh, to ulcerations 
of the small or large intestine, as after typhoid fever, or to rectal dis- 
ease, which reflexly causes hyperperistalsis. Fissure of the anus often 
causes persistent diarrhoea by reflex irritation. In those cases due to 
hyperperistalsis an advantage is often gained by directing the patient 
to take as little liquid as possible, particularly at meals, and to avoid 
coffee or other stimulants to reflex activity. Highly seasoned foods 
are also to be avoided. Meats should be preferred to vegetables, and 

1 Read with this article those on Diarrhoea and Dysentery and Enteroclysis. 



632 DISEASES. 

an absolute diet of peptonized milk may be ordered, the milk being 
given in tablespoonf uls every few minutes, rather than in large amounts. 
The patient should remain in bed. Gounterirritation, constant and as 
severe as the patient can stand, should be used over the abdomen. 
Suppositories and rectal injections seldom benefit this class of cases, 
but a pill composed as follows may be useful: 

H— Argent, nitratis gr. iv (0.25). 

Ext. hyoscyami gr. x vel xxx (0.60-2.0). 

Ext. opii * gr. ij vel iv (0.12-0.25). — M. 

Ft. in pil. No. xx. 

S. — One pill one hour before each meal. 

This pill should be coated with phenyl salicylate so that it will pass 
through the stomach before dissolving. 

In other instances some of the astringent prescriptions given under 
the article on Diarrhoea are better than the above. 

If the catarrhal state is persistent, no remedy compares to the 
chloride of ammonium, dose 5 grains (0.3) every four hours in liquorice 
and water. Where the catarrhal state is exceedingly chronic and 
obstinate it is well to employ 3- to 5-grain (0.20-0.3) doses of potas- 
sium iodide. In many cases where the condition of mucous diarrhoea 
becomes chronic it is necessary to resort to enteroclysis (Part III.) 
and the treatment needed in cases of chronic intestinal catarrh. (See 
Diarrhoea, Chronic.) 

In the cases due to ulcers of the rectum injections of nitrate of 
silver 2 grains to the ounce (0.12 : 30.0) are of value, particularly if 
followed by a 5- or 10- grain iodoform suppository. Operative pro- 
cedure against anal fissure will often cure a diarrhoea due to this cause. 

In cases of so-called morning diarrhoea abstinence from liquids 
before going to bed the night before and a very dry and small break- 
fast are to be strongly recommended, with rest in bed during the 
morning hours. 

Rockbridge Alum water, which contains iron and alum, is useful 
in cases of diarrhoea with anaemia. 

DIPHTHERIA AND MEMBRANOUS CROUP. 

Diphtheria is at first a distinctly local disease, the membrane in the 
upper air-passages forming a nidus from which the entire body ulti- 
mately becomes poisoned by the toxins of the micro-organism peculiar 
to the malady. While it is true that in some cases of membranous 
pharyngitis or laryngitis the true Klebs-Loeffler bacillus cannot be 
found, it is a fact that all cases should be treated as if they are true 
diphtheria, since in this way much good can be done, and no harm 
follows if the malady fails to develop. 

The best local application to the throat is peroxide of hydrogen. 
A cotton swab should be soaked with the undiluted 10- or 15-volume 
solution and pressed against the mucous membrane which is diseased; 



PLATE IV, 






III 




u 








Showing the Effect of Antitoxin on the Local Diphtheritic 
Process. The figures on the left show the gradual increase of the 
false membrane from the first to the thirty-sixth hour. The 
figures on the right show the disappearance of the membrane 
during the next thirty-six hours as a result of the use of antitoxin. 



DIPHTHERIA AND MEMBRANOUS CROUP. 633 

or, if this cannot be done, a spray, from a glass atomizer, of the strength 
of 1 : 4 of water may be employed. The effect is often extraordinary. 
After a few applications the false membrane appears to exist only in 
disorganized shreds. If the nasal chambers become affected, a tepid 
solution of odinary salt (7: 1000) should be used in a spray or by means 
of a fountain syringe. The child is placed with its hips on the lap 
of one nurse and its head on the lap between the knees of another, 
the dress of the nurse being protected by a rubber sheet, and the 
nasal cavities irrigated. The position of the child should be on its 
side, not on its back, and the face should be turned down sufficiently 
to allow the liquid, after entering the upper nostril, to flow out the 
lower one with ease, the child breathing through its mouth. The 
applications should be made as frequently as the membrane forms. 

Antitoxin Treatment. — This treatment excels all others in efficacy 
and usefulness, and should displace all other plans of treatment except 
the local applications. Of all the extraordinary advances made in 
pathology and therapeutics, the introduction and proof of the value 
of antitoxin in cases of diphtheria are perhaps most worthy of note, 
(For the study of Antitoxin itself, see Antitoxin, in Part III.) 

There are several facts in connection with the use of the diphtheritic 
antitoxin which should be borne in mind. The syringe for injecting it 
should have a glass barrel in order that any foreign bodies or air-bubbles 
can be seen and removed before the injection is given. The packing 
of the piston should be made of asbestos or rubber, since it is practically 
impossible to sterilize leather or other packing; and the different parts 
of the syringe should be easily disjointed in order to permit thorough 
cleansing and sterilizing. Immediately before and after the use of the 
syringe the needle should be removed and the cap taken off so that the 
sterilizing fluid may readily enter the syringe and needle, and then 
they should be placed in warm water which is brought to the boil- 
ing-point. By this gradual heating breaking of the glass barrel is 
avoided. It is best to employ one of the syringes made for the purpose. 
The injection is to be given slowly into any part of the body which 
has loose subcutaneous tissues, such as the broad of the back, the 
side of the abdomen, or the outside of the thigh. The skin at the place 
of injection should be thoroughly sterilized beforehand, and after the 
injection the fluid should be allowed to diffuse itself and not be spread 
by rubbing. 

At the present time some manufacturers of antitoxin put up their 
product in hermetically sealed bulbs, or in special containers from 
which the serum may be directly injected without the use of an extra 
syringe. The advantage of this plan is that the physician is saved the 
trouble of sterilizing a syringe and can use a fresh piece of apparatus 
for each injection. (See Figs. 109 and 110.) 

The dose of antitoxin serum is to be judged by its known strength 
or power of conferring immunity and by the severity of the disease and 
the susceptibility of the 'patient. Not less than 4000 units should be 



634 DISEASES. 

given as an initial dose and be repeated in twelve hours. The dose 
should be repeated every six or twelve hours in severe cases, and 
doubled in amount in very malignant cases or in those with deeply 
seated cervical induration or laryngeal or nasal diphtheria. Small 
doses are not required by young children. The fact that they suc- 
cumb more quickly to the disease than older children makes a large 
dose necessary. 

It has been urged against serums containing over 250 units per 
c.c. that their use is apt to be followed by untoward effects such as 
skin eruptions and local irritations. On the other hand, if the weaker 
serums are employed, such large amounts have to be given that very 
considerable swelling of the area in which the injection is given is pro- 
duced, and, of course, valuable time is lost before the whole dose is 

Fig. 109. 




Fig. 110. 



I 



L^ 




> ^rz^^dZD 



£ 



33a 



o== 



Fig. 109 shows an antitoxin container from which the antitoxin is expelled into the subcu- 
taneous tissues by means of a rubber bulb. At the other end a sterile hypodermic needle is 
attached. 

Fig. 110 represents another form of container shaped like a syringe. In it is a piston into 
which is screwed a rod Avhen the antitoxin is to be used. At the other end is attached a needle 
for the injection after the cup is removed and the glass tip is broken. 

absorbed; whereas if serums containing high immunizing power are 
employed, the small dose is quickly absorbed. In urgent cases of nasal 
or laryngeal diphtheria the stronger serums are indicated, whereas in 
the more moderate cases the lower grades of strength may be used. 

Professional opinion the world over is strongly in favor of the use 
of antitoxin in diphtheria. So far there have been published an 
immense number of reports and statistics concerning its use, and it is 
a fact that the use of antitoxin is of the greatest value. Whereas 
the average death-rate without antitoxin varies from 25 to 65 per 
cent, according to the severity of the epidemic, with the use of anti- 
toxin it falls as low as 16 or even 8 per cent. 

The author cannot too strongly urge upon the reader the vital 



DIPHTHERIA AND MEMBRANOUS CROUP. 635 

importance of using antitoxic serum early and freely. The reports 
in which it has been condemned are imperfect and unreliable. It 
has been claimed by some persons that since the use of antitoxin 
more cases of complications or sequelae are met with than ever before. 
The reason is manifest, viz., that before antitoxin was used all the 
very malignant cases died, whereas a large percentage of these are now 
saved, and suffer from lesions which if antitoxin had not been used 
would have been fatal. Every patient who apparently suffers from 
the disease should receive this remedy, so potent for good and so 
lacking in harmful qualities even when given to non-diphtheritic 
persons. The physician who can obtain the serum and does not use 
it is not doing the best thing for his patient. 

Much depends upon the early use of the remedy, for after degen- 
erative changes have taken place in the heart and kidneys the damage 
is done. Statistics show that in cases which receive the antitoxin on 
the first day the mortality is often only 3 to 5 per cent., whereas with 
each day of delay the percentage rises, so that when it is not given 
till the fourth day the mortality is as high as 40 per cent. As the 
use of antitoxin does no harm, it should be employed in all doubtful 
cases of diphtheria without waiting for a bacteriological diagnosis. 

When the antitoxin is given, general improvement usually takes 
place in twelve to thirty-six hours, and the temperature falls. The 
spread of the membrane is arrested and its separation soon begins. 

Although the use of antitoxin for immunizing purposes when 
persons have been exposed to infection has been resorted to, it is not 
practised by the general body of the profession to the extent that it 
should be. The use of 1000 normal antitoxin units will usually pro- 
duce immunity for three or four weeks. 

Full doses of antitoxin of the higher potencies sometimes give rise 
to pains in the joints or to an erythematous eruption, which are without 
danger and need not excite alarm. 

The only new local application which promises much is that of 
Loeffler. He directs that the mucous membrane shall be carefully 
wiped off by a pledget of cotton, and after this is done that a second 
pledget dipped in the following solution shall be pressed against the 
diseased area for ten seconds at three-hour intervals: menthol 2\ 
drachms (10 grammes) dissolved in 9 drachms (36 c.c.) of toluol, to 
which are added 1 drachm (4 c.c.) of liquor ferri chloridi and absolute 
alcohol 2 ounces (60 c.c). This solution, if kept in a dark glass bottle, 
well stoppered, will keep for months. The author prefers to use per- 
oxide of hydrogen in all cases, as it is efficacious and painless, whereas 
the application of Loeffler's solution is apt to be very painful. 

The local use of iodine, phenol, and similar irritating and poison- 
ous substances is not justifiable. 

Great care as to the prevention of the disease is needful. All cases 
should be carefully isolated ; children who have been exposed should 
be quarantined for fourteen days; persons in perfect health who have 



636 DISEASES. 

been nursing such patients should also be quarantined, for in the 
secretions of the throat diphtheria bacilli may be carried by an appar- 
ently healthy nurse to another patient. The nurse and physician 
should therefore gargle with saline solutions and follow this by anti- 
septic mouth washes, using the greatest cleanliness as to the hair, 
hands, face, and clothing. 

The maintenance of the patient's strength during an attack of 
diphtheria is of great importance. Simple, easily swallowed, and 
easily digested food should be freely given, and plenty of water pro- 
vided to allay thirst and flush the kidneys of poisons. Milk, pre- 
digested or plain, is useful, as is also properly made beef -tea (see 
Feeding the Sick); soft eggs, etc., are to be given; and if swallowing 
is difficult because of soreness or paralysis, then we must feed by the 
use of the soft-rubber nasal tube, inserted through the nasal cavities 
into the pharynx after being well oiled with albolene. (See Gavage, 
Part III.) Such a method of feeding may be resorted to in cases 
of inability to swallow arising from paralysis and consequent regurgi- 
tation; in coughing which prevents swallowing, as in tracheotomy 
cases; and in the vomiting which sometimes follows swallowing, but 
often does not follow nasal feeding. It is best to use throat applica- 
tions before giving the food, in order to avoid vomiting. 

Feeding by the rectum may also be resorted to, and hypodermoclysis 
is not to be forgotten for the purpose of supplying fluid to the tissues. 

Tincture of the chloride of iron, quinine, and strychnine are of 
service to keep the kidneys active, to stimulate the heart and respira- 
tion, and to support the vital forces. The dose of the tincture of iron 
may be as much as 2 minims (0.1) every hour to a child of four years. 

Steam set free in the air of the room is very useful as an adjuvant to 
local treatment, and the bronchitis-tent may be used in laryngeal cases. 

A method of using turpentine by inhalation was highly recommended 
by J. Lewis Smith. The following prescription is placed in water in 
the proportion of 2 tablespoonfuls (30.0) to a quart (960 c.c.) , and this 
mixture is then placed on a gas or oil stove in a broad, open vessel and 
allowed to boil constantly. The air of the sick-room is soon laden with 
the vapor, which is not offensive. The prescription is as follows: 

R— Phenol., 

Olei eucalypti aafgj(30.0). 

01. terebinthinae '. fgviij (240.0).— M. 

S. — Use as directed. Label: Poison if taken internally. 

In other cases there is no doubt that calomel by sublimation does 
great good. The child is placed in a bronchitis-tent and from 45 to 
75 grains (3.0 to 5.0) of calomel are placed in a sublimator and 
gradually vaporized into the air the child breathes. 

When the glands of the neck threaten to suppurate, ice-bags should 
be applied to the throat and pieces of ice held constantly in the mouth, 
while the tincture of iron is pushed in as full amounts as possible. 



DROPSY. g37 

If suffocation is imminent, inhalations of oxygen are to be used and 
atropine or strychnine employed, but intubation or tracheotomy is 
usually the safer plan of treatment. 

Chlorate of potassium has been used purely empirically in the treat- 
ment of this disease, but it should never be given internally, as the 
kidneys are already overburdened, and this drug is not only useless 
when so given, but is in addition a renal irritant. Although the author 
has been criticised for this last statement, he is convinced of its truth. 

DROPSY. 

Dropsy is to be regarded as a symptom (not as a disease in itself) 
which may arise from many causes, such as cardiac, pulmonary, or 
renal diseases, or it may depend upon obstruction, from various causes, 
to the normal flow of the blood and lymph through the vessels and 
tissues. Its existence is dependent upon so many causes of a still 
more indirect nature that it is almost impossible to notice all of them, 
but the following consideration of the subject will at least make clear 
some of the reasons for its occurrence and indicate the means which 
are to be taken for its relief. 

At the very start we are confronted by facts which seem para- 
doxical, but which are in reality quite reconcilable. These are, that 
low arterial pressure predisposes to dropsy, and that high venous 
pressure does likewise, or, in other words, that the cause of exudation 
on one side of the circulation is its prevention on the other. 

The explanation of these statements lies in a thorough under- 
standing of the physics of the circulatory system and its anatomical 
structure. It will be remembered that dropsical exudation takes 
place from the capillaries, and that the integrity of the walls of the 
bloodvessels and lymphatics depends upon normal nutrition, or, in 
other words, upon a proper blood-supply. As a consequence, dropsy 
may be due to poorly nourished vessels as much as to any other cause. 

The force exercised upon the column of blood as it is driven out 
by the heart into the aorta may be considered as the chief support of 
the capillary circulation, so that if the heart be weak the pressure 
falls in the arteries, and in consequence the rapidity of flow is de- 
creased in the capillaries, while, on the other hand, an increased 
cardiac activity hastens the capillary circulation. As the arterial 
pressure and force depend not only upon the heart force, but also 
upon the tonicity of the arteries which carry the blood-stream, it 
becomes evident that dilated arteries must lower blood-pressure even 
if the heart be strong, although practically the heart and vasomotor 
system generally fail or increase in tone together. We find, there- 
fore, that a weak heart or a relaxed artery tends to cause stagnation 
of the blood in the capillaries, and, having found that such stagnation 
is productive of exudation, it is not difficult to understand why low 
arterial pressure aids in the development of dropsy. 



638 DISEASES. 

Having shown this to be true, let us turn to an explanation of the 
fact that a high pressure in the veins is productive of the same changes. 
Here the normal pressure is almost nothing, being much less than 
in the arteries, and considerably less than in the capillaries. The 
result of this is, that in health the blood flows rapidly from the high 
pressure of the artery to the low pressure of the vein, and passes 
through the small veins under a gradually decreasing pressure until 
it reaches the heart. Any obstruction to this venous flow must increase 
the venous pressure, and, the venous pressure being increased, the 
rapidity of flow through the capillaries must be decreased. The 
whole subject may be made more clear by the following example: 

Suppose that two iron tubes are connected at the ends by several 
lines of rubber tubes (the capillaries), and that water is flowing into 
the first tube, or the artery, under a pressure which is represented 
by the figure 100, while the resistance to the flow in the second tube, 
the vein, is represented by the figure 0. It at once becomes evident 
that the rapidity of the flow through the connecting rubber tubes will 
be very great, whereas if the pressure in the first or arterial tube is 
decreased to 50, the rapidity is decreased to one-half, or if the pressure 
in the second tube be increased to 50 instead of remaining at 0, the 
same changes will occur; in either instance capillary flow is lessened 
and exudation is caused. This is a crude explanation of what may be 
called the mechanical pathology of dropsy. 

There can be no doubt that even more important causes are altera- 
tions in the vessel walls and in the constitution of the blood-serum 
as to salts. 

In cardiac disease dropsy is due to a weak heart being unable to 
supply the arteries with enough blood to maintain the normal pressure, 
or to a damming-up of blood in the venous system as the result of the 
imperfect emptying of the cardiac cavities. In the first instance low 
arterial pressure produces dropsy; in the second, high venous pressure 
has a similar effect. 1 

In renal troubles the dropsy depends more upon the lack of proper 
nutritive processes in the capillary walls and upon changes in the blood 
and blood-pressure than upon other causes. If the kidney is diseased, it 
may not be able to eliminate the proper quantity of liquids, which 
accumulate and finally escape into the tissues, while the same failure 
in renal function causes disease of the bloodvessels themselves, and 
often produces cardiac complications. 

Hepatic troubles cause dropsy by producing pressure upon the large 
bloodvessels going to the liver, and, in consequence, the exudate is 
generally confined to the lower limbs and abdomen. If the hepatic 
trouble be severe, some failure in the nutrition of the bloodvessels and 
changes in the quality of the blood may ensue. 

Pulmonary disease rarely causes dropsy unless the venous pressure 

1 For an explanation of these changes in the action of the muscles, valves, and cardiac 
action in heart disease, see the article on Heart Disease, 



DROPSY. 639 

is greatly increased and productive of cardiac dilatation, or, as in 
phthisis, where the changes in the nutrition of the body involve the 
bloodvessel walls and the blood. 

Having spoken of these causes of dropsy, it remains to con- 
sider its treatment, which may be divided into two parts — namely, 
that directed to its removal after the liquid is poured out, and its 
relief or cure by direct attention to its causes. The means for the 
removal of the fluid are suitable to all cases, be the cause what it may, 
unless the dropsy be of renal origin. Whenever an accumulation of 
liquid takes place in the tissues, drugs or measures must be resorted 
to which will cause the emunctories of the body to get rid of it. We 
may employ elaterium in the dose of \ grain (0.01), or elaterin 
in the dose of -%~w g ram (0.003), placed in the mouth and washed 
down by a little water, or the compound jalap powder may be re- 
sorted to in the dose of 20 to 30 grains (1.3-2.0), and to it may be 
added, to increase its efficiency, 15 grains (1.0) more of bitartrate 
of potassium than the official powder contains. These two remedies 
are particularly serviceable in renal dropsies, since the elaterium is 
supposed to aid in the elimination of urea by the bowel, while the 
cream of tartar in the jalap powder increases the action of the kidneys. 

The cream of tartar is not to be employed in cases of acute 
nephritis. 

Compound extract of colocynth may be employed in the dose of 
5 to 15 grains (0.3-1.0), according to the state and idiosyncrasy of the 
patient. 

All these remedies relieve dropsy by causing so great an outpouring 
of liquid from the bloodvessels of the intestine that the liquids in 
the tissues are taken up by the depleted bloodvessels to replace the 
loss through the action of the purgative. In other words, these 
purgatives render the alkalinity of the blood greater by concentration, 
and absorption of fluid occurs by reason of the following physiological 
and physical facts: 

As is well known to every physiologist, the passage through a blood- 
vessel of a salt solution of less than 0.7 per cent, causes an abstrac- 
tion of salts from the surrounding tissues by the circulating fluid, in 
order that the amount of salts in the vessels and tissues may be identical. 
At the same time the tissues become infiltrated with liquid. On the 
other hand, if the solution be stronger than the normal, the liquid 
leaves the tissues to enter the vessels, and the tissues in consequence 
shrink. 

When salines are given to relieve dropsy, they must be admin- 
istered in concentrated or saturated solution and on an empty stomach, 
total abstinence from the drinking of water being insisted upon until 
they have fully acted, for the reasons given in the last paragraph. 
For this reason they should be given an hour or so before breakfast. 
If these directions are not followed, this method of treatment is useless. 
(See Magnesium Sulphate.) 



640 DISEASES. 

The other means which we possess for the removal of dropsy are 
by way of the kidneys and skin. If the kidneys are hopelessly dis- 
eased, that pathway is almost useless; but if they are only passive or 
partly inactive, diuretics may be used to stimulate their secreting 
structure and to increase the leakage of liquid through them by increas- 
ing blood-pressure. Such patients should be placed almost entirely 
on a milk diet, and many of them will greatly improve under the use 
of buttermilk to the exclusion of other nourishment. If this cannot 
be taken, sugar of milk may be employed as an active diuretic. (See 
Sugar of Milk.) 

Often the kidneys will be found inactive because, owing to conges- 
tion from cardiac trouble, they cannot act. Under these circumstances 
digitalis, in 5- or 15-minim (0.30-1.0) doses of the tincture, given 
three times a day, will be of value, and its efficacy will be increased 
by the addition of 1 minim (0.05) of the tincture of cantharides if the 
renal lesion is exceedingly chronic or mere torpidity exists. Digitalis 
and squill, in pill form, as follows, may be used: 

Py— Pulv digital. . . . gr. xx (1.3). 

Pulv. scillse gr. xx (1.3). — M. 

Ft. in pil. No. xx. 

S. — One every five hours. 

Or digitalis and calomel may be employed in pill form in renal and 
cardiac dropsies. Apocynum cannabinum is also a useful drug in 
this state. (For another useful formula see article on Heart Disease.) 

Caffeine is also a useful diuretic, particularly in torpidity of the 
kidney, as it stimulates the secretory epithelium, thus eliminating urea 
and other effete matters, and increases the passage of liquids by the 
increased blood-pressure which it produces. 

That a large amount of liquid may be gotten rid of through the 
skin under the influence of heat is well known. (See Heat, Part III.) 
In addition to external heat pilocarpine has been used by the mouth or 
hypodermically in localized dropsies, to produce absorption and con- 
sequent elimination of liquid by sweating. No drug should ever be 
given hypodermically in dropsy of a general character, as it will not 
be absorbed from the water-soaked tissues with any rapidity, if at all. 

The chief means of relief to be resorted to in cases of ascites istapping. 
Efforts to remove effusions in the peritoneal cavity by medicinal 
measures are rarely followed by success. In reality, tapping is far 
less heroic treatment than purgation, and the old theory that it is 
dangerous has been disproved. It has been found that tapping 
not only removes the fluid, but may in some unknown manner pro- 
duce a permanent cure after from one to twenty or more operations. 
In performing tapping, the patient is to be placed in a sitting or semi- 
recumbent position, and directed to evacuate his bladder, so that there 
will be no danger of this viscus being injured by the trocar. The 
skin of the abdomen in the middle line one or two inches below the 
umbilicus is next benumbed by salt and ice held against it. The 



DYSMENORRHEA. 641 

physician then takes a trocar and canula, at least four inches long, 
and pushes it through the abdominal wall until by the decrease in 
resistance he knows its point has entered the abdominal cavity. It is 
well to have a broad abdominal bandage placed around the belly, so 
that an assistant by pulling on its ends may support the belly-walls 
when relaxed by the escape of the effusion. As a rule, not more than 
one-half or three-fourths of the liquid should be removed at one 
sitting, as its entire removal may be followed by collapse. 

The value of iodide of potassium in cases of ascites is not to be 
forgotten, but it must be given cautiously if renal disease is present. 

Where the tenseness of the skin in the lower extremities causes 
danger of local sloughs, several free incisions for the escape of the 
liquid should be made, the limbs being encased in sterilized absorbent 
cotton to absorb the liquid. 

DYSENTERY. 

(See Diarrhoea.) 

DYSMENORRHEA. 

The existence of dysmenorrhea depends upon so many conditions 
that the treatment employed in one case is seldom productive of 
success in the next. This is not the place for a consideration of the 
surgical measures adopted for the cure of this symptom, and only the 
medical treatment will be spoken of. 

When dysmenorrhcea results from the taking of a cold, and is 
accompanied by uterine congestion and irritability, the following 
measures are particularly valuable, and may do good in many cases 
depending upon other causes: The patient should take a hot sitz- 
bath, and immediately get into bed as soon as the buttocks are dried, 
being well covered while in the tub and afterward by a blanket. A 
turpentine stupe is now to be used (see Turpentine), and 10 grains 
(0.60) of Dover's powder to be administered unless an idiosyncrasy 
toward opium is known to exist, when a half or a fourth of this amount 
may be employed. Often when the attack is accompanied by consti- 
pation a purgative dose of Epsom salt is of service. 

If the pain is persistent and severe, a belladonna suppository, of 
\ grain (0.03) of the extract, may be inserted into the rectum, or in other 
cases belladonna ointment smeared over the os uteri will be found of 
service. The latter method is generally impracticable and is rarely 
resorted to. Very commonly belladonna tincture, by the mouth, is of 
service in relaxing the spasm of the cervix and of the uterine fundus. 

Some practitioners resort to the use of opium at each epoch, and 
keep the patient partially narcotized until menstruation is passed. 
This is unjustifiable and born of ignorance and bad practice, since 
the physician is simply dodging effective treatment of the trouble 

41 



642 DISEASES. 

and predisposing the patient to future attacks by reason of the consti- 
pation and the resulting habit which is almost sure to appear after 
the repeated employment of opiates. 

When the dysmenorrhea is due to obstruction of the cervical canal 
by organic changes or flexions, these conditions must, of course, be 
relieved before a cure can be expected, and the medical treatment 
can be directed only to alleviation of the pain. Divulsions or slow 
or rapid cervical dilatation should be carried out by the use of instru- 
ments. 

In neuralgic dysmenorrhea, dependent rather upon nervous dis- 
order accompanying menstruation than upon menstruation itself, 
measures directed to the improvement of the nervous system and the 
nutrition of the patient are necessary. (See Rest Cure.) These cases 
generally occur in nervous, anaemic women run down by excessive 
dancing or other gayety or by the bearing and care of a large family 
of children. 

A course of strychnine or quinine and iron in small doses is often 
beneficial in these cases, and horseback exercise between the men- 
strual periods, out-of-door life, and avoidance of excessive dancing 
and exhausting exercise are to be ordered. 

Cannabis indica and gelsemium are often of great service, both as 
cures and alleviators of the pain, and antipyrin, acetanilid, and similar 
drugs may be resorted to while the attack lasts if it be neuralgic. 

Sometimes bathing the loins, between the periods, with alternate 
dashes of hot and cold water may do good in atonic patients. In 
other cases a hot vaginal douche at the onset of pain may give relief. 

When the pain seems to be greater than the patient can bear, enough 
ether or bromide of ethyl should be given by the physician, by means 
of inhalation, to produce the primary stages of anaesthesia; but chloro- 
form is not advisable, as the patient, if taught its value by the medical 
attendant, may resort to this dangerous drug without advice and die 
from an overdose. 

DYSPEPSIA. 

(See Indigestion.) 

DYSPNCEA. 

Shortness of breath, or dyspnoea, arises from asthma, cardiac weak- 
ness, abnormal innervation resulting in cardiac palpitation, from the 
accumulation of fluids in the chest, from the involvement of the lungs 
by any disease process in such a way that respiration becomes im- 
paired, or it is produced by indigestion, or, finally, by the encroach- 
ment on the lungs or chest- walls of morbid growths. It may also 
be due to uraemic or diabetic toxaemia. 

Each of these states must be removed to effect a cure, but it is only 
of the relief of the symptoms that we will speak. 



EARACHE. 643 

In old persons who suffer from dyspnoea the result of bronchor- 
rhcea, where a large amount of liquid fills the bronchial tubes and 
shortness of breath follows exertion, strychnine is the best remedy. 
Its value depends upon its powerful influence over the respira- 
tory centres, on which it acts as a stimulant; and as these cases 
very commonly also have dilatation of the right side of the heart, 
with consequent cardiac enfeeblement, strychnine is of additional 
service through its influence upon the circulation. These individuals 
are not to be given opium or its alkaloids or any sedative drugs, as 
such medicines, while giving temporary relief from cough, only serve 
to depress the respiratory apparatus and cause an accumulation of 
liquid mucus in the chest as a result of the prevention of cough 
and expectoration. The cases in which opium, or morphine, does 
good are those in which, through nervousness or functional nervous 
disorder, the respiratory cycle is imperfect, and, above all, in those 
instances in which dyspnoea occurs as the result of cardiac disease. In 
these cases the attacks of oppression and suffocation can often be 
entirely prevented by the use of \ to \ grain (0.008-0.015) of morphine, 
given every night or each night and morning. If these doses fail, 
larger ones may be cautiously used. Hyoscine, instead of causing 
sleep, nearly always makes these cases worse. 

Sometimes a little carbonate of ammonium is useful as a respiratory 
and cardiac stimulant in cases of dyspnoea. 

Dry cupping applied over the back of the chest may also be service- 
able when shortness of breath from cardiac or pulmonary trouble is 
present. 

In cases of dyspnoea due to emphysema and pulmonary inflam- 
mation of a chronic type, or in those persons who take cold on the 
slightest exposure, particularly after attacks of asthma, arsenic is 
useful if continuously employed. 

If pleural effusion be present, relief of a positive and lasting nature 
can only be obtained through aspiration, or, in other words, by the 
operation known as paracentesis thoracis. 

EARACHE. 

Earache may arise from a great number of causes, all of which 
are, practically speaking, inflammatory. The pain may be the result 
of acute or chronic inflammation of the middle ear, with a serous or 
purulent exudate, or of furunculosis of the external auditory canal. 
In other cases an eczema of this part is very painful. 

The treatment of an acute earache is systemic and local, the 
former being based on the general rules governing the management 
of inflammatory processes, the latter according to the area involved 
and the cause of the trouble. Cardiac sedatives are indicated, but 
quinine is distinctly contraindicated, as it tends to cause aural con- 
gestion. In the general treatment several leeches may be placed in 



644 



DISEASES. 



Fig. 111. 



front of or behind the ear, and heat in a dry form is to be applied to 
the head on the side affected, by means of a hot-water bottle or water- 
bag. Poultices, oil and laudanum, and 
similar applications are not to be re- 
sorted to, as they may ultimately produce 
too extensive suppuration, and they do 
not always give even temporary relief, 
but tincture of belladonna and tinc- 
ture of opium in equal parts carefully 
warmed may be dropped in the ear in 
the dose of 5 to 10 minims (0.30-0.60) 
when necessary. 

A very efficient means of relieving the 
pain is to irrigate every hour or two the 
ear by means of a fountain syringe with 
normal salt solution, used as hot as can 
be borne. (Fig. 111.) 

If a cold in the head is present, and 
with it acute myringitis, it is important 
to establish a free opening through the nostrils, particularly if the 
middle ear also is involved, in order to clear the orifice of the Eustach- 
ian tube. This is to be accomplished by dropping into each nostril 
adrenalin chloride (1:5000 solution) or 1 to 3 minims (0.05-0.20) 
of a 4 per cent, solution of cocaine, and, as soon as the engorged 
mucous membrane is anaesthetic and shrunken, to use the following 
solution in an atomizer with a fine spray attachment : 




Aural irrigator. 



1^ — Acid, boric. . 

Sodii chlorid. 

Sodii borat. . 

Aq. rosse . . 

S. — Use as a spray. 



q. s. ad 



gr. x (0.60). 
gr. xij (0.8). 
gr. x (0.60). 
fgiij (90.0).— M. 



This should be followed by a spray of menthol and albolene, 3 grains 
to the ounce (0.20: 30.0), in order that the menthol may prolong the 
effect of the cocaine and prevent secondary congestion. This is to 
be followed by inflation of the Eustachian tube with a Politzer 
air-bag. Only in most obstinately painful cases of acute middle-ear 
catarrh is paracentesis of the drum to be performed. 

Should true septic otitis media develop and drainage of the middle ear 
become impossible through blocking of the Eustachian tube, then the 
physician must very gently irrigate the external auditory canal with as 
hot water as can be borne, and render it aseptic by insufflations of 
boric-acid powder. These injections should be frequently practised, 
and if the pain persists and the tympanic membrane is bulging, para- 
centesis must be performed in the most bulging part of the lower 
quadrant. After the paracentesis needle is withdrawn the discharge 
should be allowed to flow freely. The canal is then to be well irrigated 
with hot carbolized water (1 :50), and as the discharge is constant a 



ECZEMA. 645 

piece of sterilized cotton should be inserted and removed as often as 
soiled. 

In the case of eczema of the ear hot irrigation, followed by the 
application of powdered iodoform, is perhaps the best application for 
temporary treatment. In furunculosis of the ear hot irrigation and 
free incision, with an iodoform dressing, are also useful. 

When foreign bodies cause the pain, they are best removed by 
repeated and gentle syringing with hot water. Forceps are dangerous 
instruments in the hands of a novice treating the ear. 

In earache due to neuralgia a small compress wet with chloroform 
may be applied to the skin in front of and behind the ear. 

ECZEMA. 

This is probably the most common form of skin disease which the 
physician is called upon to treat, with the exception of acne. 

Dermatologists divide it into many forms and stages, but in this 
book a consideration of its forms is out of place, and only the treat- 
ment for its stages is proper. 

In the first place, it may be stated that the treatment is a quadruple 
one — namely, dietetic, hygienic, external, and internal. 

In regard to diet, the patient should be told to avoid salty foods, 
such as salted fish or pork and corned beef; greasy foods, such as bacon 
and fried dishes; pastry and cheese. At most only moderate amounts 
of wine and beer can be taken, and foods difficult of digestion are to be 
stricken off the bill of fare. 

In the way of hygienic measures, fresh air, the avoidance of sedentary 
habits, horseback exercise or walking are to be recommended. 

External treatment is the most important of the two measures in 
which drugs are employed, and its course is perhaps best described 
by taking a case of ordinary eczema as an example and treating it 
through its entire course. 

In the early stages of an acute eczema, when the process is very 
active and the erythematous reddening is merging into the forma- 
tion of vesicles or pustules, with the formation of large scabs, 
no application is better than oxide-of-zinc ointment, thoroughly 
applied night and morning. If the eczema be situated upon the 
scalp, the hair must be invariably clipped short or shaved off in 
such a way as to prevent the gluing of the hair into a mat by 
reason of the discharge. The ointment may be smeared over the 
part or applied on a piece of lint in a thick layer. Nearly always 
the ointment should be used in conjunction with black wash (calomel 
1 drachm [4.0], lime-water 1 pint [480.0]), which should be applied 
twice a day, just before the zinc ointment is resorted to, by means of 
a swab or a sop, and allowed to dry. In other cases the powdered 
oxide of zinc is dusted over the part if the discharge is very watery 
and profuse, or the following ointment, recommended by McCall 
Anderson, is very efficacious: 



646 DISEASES. 

ty— Bismuth, oxidi ........ gj (30.0). 

Acid, oleic, pur. ....... Bviij (240.0). 

Cerse albae ......... giij (90.0). 

Petrolati . §ix (270.0). 

Olei rosse mv (0.3).— M. 

Ft. in unguent. 

S. — Apply to the part affected. 

As the quantities of this prescription are large, they may be reduced 
one-half for use in localized eczema. 

Where the proliferation of cells and the secretion are very profuse 
it may become necessary to remove the crusts before the local remedies 
can reach the skin, and for this purpose poultices may be used; or, if 
the disease be on the face, the parts should be anointed with olive oil, 
containing 1 or 2 minims of carbolic acid to the ounce (0.05-0.1 : 30.0), 
to soften the crusts, which are readily removed in a half-hour by 
the use of castile soap and water. The soap is not to be used if 
the inflammatory area is very angry-looking. Whenever itching is 
an annoying factor, the parts should be protected by lint smeared 
with some simple ointment, which may be carbolized both for its anti- 
septic and local anaesthetic effect. English and American dermatolo- 
gists use what is known as liquor carbonis detergens very largely in 
the acute stages of eczema. It should not be used pure, but diluted 
in such a way that for each 4 ounces (120.0) of water 2 drachms 
(8.0) of the pure liquor are present. Liquor carbonis detergens is made 
by taking 9 ounces (270.0) of tincture of soap-bark (quillaia-bark) 
and 4 ounces (120.0) of coal-tar, mixing and allowing them to digest 
for eight days, after which the mixture is filtered and is then ready 
for use. 

When the disease has passed from the acute, active inflammation 
of the first stage to the subacute form of the second stage applications 
of a mildly stimulant character are necessary. Before this the 
aim has been to soothe the parts; now they must be excited to 
normal activity. For this purpose resorcinol in the proportion of 2 to 
30 grains to the ounce (0.12-2.0 : 30.0) of lard, according to the severity 
and induration of the lesion in the skin, should be used. Stelwagon 
recommends the following: 

1$ — Unguent, picis liq 3j (4.0). 

Unguent, zinci oxidi . . . . . . 3vij (28.0). — M. 

S. — Apply to the parts. 

Where the disease is chronic and very persistent, and sluggish or 
atonic in its course, still more powerful remedies are necessary, such as 
salicylic acid, tar, or tincture of green soap used with hot water until 
the skin beneath is bared, dressing this by means of zinc ointment or 
resorcinol ointment, 2 to 10 grains to the ounce (0.12-0.60 : 30.0), 
spread on a cloth. The salicylic acid should be used in the propor- 
tion of 30 to 60 grains to the ounce (2.0-4.0 : 30.0) of lard, while the 
tar is used in the form of the pure official tar ointment. 






EMISSIONS. ^47 

In seborrheic eczema, where the secretion is greasy and dry, and 
complicated, if wrongly treated, by oozing and the pouring out of 
serum and the formation of cells which form crusts, the following pre- 
scription is of value: 

1$ — Resorcin gr. x vel xx (0.60-1.3). 

Pulv. amyli, 

Unguent, zinci oxidi . . . . aa oij (8.0). 

Petrolati 5ss (16.0).— M. 

S.— To be applied after removing the scabs by the use of a lotion composed of 
1 part of bay rum and 3 parts of water. 

The internal treatment is directed to the cure of any disordered 
function which is present, such as dyspepsia (see Indigestion), hepatic 
torpor, general debility, ansemia, scrofulosis, inanition, constipation, 
gouty diathesis, or renal insufficiency. The gastric disorder is to be 
relieved by the use of hydrochloric acid and pepsin; the hepatic tor- 
por by mercury, podophyllin, or, better still, by freshly prepared 
undiluted nitrohydrochloric acid added to water; the debility by 
tonics, such as cinchona, cod-liver oil, strychnine, and bitters; the 
amemia by iron, and, if scrofulosis exists, by the syrup of the iodide 
of iron. Constipation is to be cured by the use of proper foods and 
laxatives, and the gouty tendency counteracted by the employment 
of the salicylates, lithium citrate, colchicum, or potassium iodide. If 
the kidneys are at fault because of torpidity, the diuretic potassium 
salts, such as the citrate, are indicated. Arsenic is never to be 
used, except in those instances where the skin is very dry, and 
where, by improving digestion and through its alterative power, it 
may do good. In the chronic forms of dry eczema or those depend- 
ing upon an atonic state of the trophic nerves of the skin, arsenic 
is of great value in the form of Fowler's solution, or arsenic trioxide 
may be given. 

EMISSIONS. 

Seminal emissions occur as the result of sexual abuse, whereby a 
condition of hyperexcitation of the nerve cells in the spinal cord and 
the nerves of the genitalia is developed, or they are due to peripheral 
or centric irritations, which reflexly irritate the genitalia or their nerves, 
and to a number of other similar causes. These emissions also occur 
with some periodicity in normal males who are continent and chaste, 
and under these circumstances are not to be interfered with by treat- 
ment unless the emissions become excessive. 

The former types are, however, proper for medical treatment, and 
their cure consists in the avoidance of unchaste literature and lascivious 
thoughts during the waking hours, and the use of such spinal and 
cerebral sedatives that the centres governing the ejaculations of semen 
may be calmed, and so quiet a sleep produced that erotic dreams are 
avoided. The patient should sleep on a hard hair mattress, not be too 
heavily covered, and should avoid sleeping on his back, as this causes 



648 DISEASES. 

an undue blood-supply to the spinal centres, and consequent stimula- 
tion and ejaculations. Sometimes hard bodies, such as spools, are 
tied around the loins, so that lying on the back will cause so much dis- 
comfort that the patient awakes and turns on his side. The drugs to 
be used are bromide of potassium or sodium in 20-grain (1.3) doses at 
bedtime, or chloral may be taken in the same amount. Hyoscine 
is certainly of value in the dose of T -J-g- grain (0.0006). Sometimes a 
warm sitz-bath or general bath before going to bed is of service. In 
other cases, where atony is the cause of the trouble, the physician 
should recommend cold sponging of the perineum and loins night and 
morning. 

In the cases in which emissions come on as the result of continence, 
and become excessive, the remedies just named are to be tried, but 
do not effect any permanent cure unless used until sexual power is 
seriously depressed, so that it has been the custom of many physicians 
to recommend "marriage," which the patient may interpret in its 
legitimate light or not as he pleases. 

It is worthy of note that all irritations of the urinary bladder and 
other parts of the genito-urinary system should be removed, and it 
is often of value to administer citrate of potassium in 20-grain (1.3) 
doses, in water, three times a day, to render the urine non-irritating 
and alkaline. Stimulating foods and drinks are to be interdicted, 
and condiments, such as pepper and mustard, avoided. 

Sometimes, when the emissions are caused by genital atony, strych- 
nine and arsenic are of great service if given in full dose. 

In many of these cases it is the duty of the physician to treat the 
moral state of his patient as well as to give medicines. Many per- 
sons, believing that emissions are always an evidence of disease, read 
books on such subjects which are sold by quacks, and soon find their 
way to the hands of these persons. A few sensibly consult a regular 
physician. Half the treatment in these instances consists in assuring 
the patient that he has nothing to worry about, and in making him 
feel that the physician is his friend and worthy of all confidence and 
complete belief. 

ENDOCARDITIS. 

Endocarditis may be acute or chronic. Acute endocarditis occurs 
as a result of some general infection which is usually rheumatism. 

In acute sthenic endocarditis tincture of aconite, 3 minims (0.20) 
given every hour until the physiological symptoms of its influence 
are present, is useful, or with equal efficacy may be employed the 
tincture of veratrum (10 to 15 minims [0.60-1.0]). In most 
cases it is better to apply an ice-bag over the heart. Aconite and 
other depressants are contraindicated if the heart is at all feeble, 
and should only be used in the earliest stages of the disease. The 
most important measure is absolute rest upon the back. This must 
be insisted upon. If the cause of the disease is acute rheumatism, a 



EPILEPSY. 649 

number of small blisters placed on the praecordium will be of value in 
preventing endocardial complications. (See Acute Rheumatism.) 
If the disease becomes ulcerative, supporting treatment, consisting 
chiefly in the use of good food and the free administration of the 
tincture of the chloride of iron, is of great value. 

EPILEPSY. 

The disease known as epilepsy is probably the most disheartening 
condition as to treatment that the physician has to deal with, since it 
often resists the influences of all the standard remedies, and drives 
the practitioner from drug to drug in the hope of finding one which 
will be at least alleviating in its effects. For this reason the author 
has in this article included many of the drugs which are rarely used, 
as well as those generally recognized as useful in its treatment, in 
order that the physician may try every remedy of any possible value. 
In the treatment of epilepsy the fact must be borne in mind that the 
convulsions are the result of a lack of nervous control or balance. In 
idiopathic epilepsy there exists a state of impaired nervous equilibrium 
with the result that explosions of nervous energy take place from the 
motor cortex of the cerebrum. These cases almost always develop 
in childhood and are dependent upon a congenital defect. A careful 
examination of them will nearly always reveal signs of their not being 
perfectly balanced mentally and physically. At the same time epilepsy 
is not a disease of idiots by any means. Often sufferers from it are 
remarkably clever, at least for many years. It is evident that in cases 
such as these the physician cannot hope to cure the patient per- 
manently, although by proper feeding, hygienic measures, and suitable 
drugs and tonics he may diminish the attacks very greatly. So, too, 
by removing causes of peripheral irritation he may diminish the fre- 
quency of the attacks, but he cannot eradicate the underlying nervous 
instability. If the condition arises in adult life, it is in the great major- 
ity of cases due to syphilis, to brain tumor, or to injuries of the skull. 
Under these conditions the prognosis and therapeutic possibilities are 
better than in the type just described; but if the fits have lasted for any 
length of time, so that a state of instability of the cerebral cells has 
been established, the condition may be irreparable, even if the treatment 
be most skilful. 

So far as drugs are concerned, the most valuable remedy in use for 
the relief of epilepsy is bromide of potassium, although other bromine 
salts will be mentioned later. 

Bromide of potassium is not a specific, but many cases prove that 
the remedy gives relief when it is used in a suitable manner, and in 
a large number of instances the seizures are so decreased both in vio- 
lence and frequency that its use may be said to be indicated in almost 
every case of the disease at some period in its course. In a very 
small minority, however, it signally fails. 



650 DISEASES. 

The doses to be used vary to a considerable extent with the salt 
employed, and depend upon the character of the disease and the tem- 
perament and physique of the patient. The greater the duration of 
the disease, the greater is the difficulty in effecting relief, and the 
length of time during which the patient has been epileptic should 
therefore be most carefully reckoned before the treatment begins. 
Further than this, the frequency and severity of the attacks are to be 
looked into, and these points are really more important than the actual 
duration of the ailment; since if a man has only one fit every six 
months for twenty years his condition is far less serious than if he has 
a history of three or four fits a day for one year. Again, the character 
of the attack, as to its violence, may be the most important fact to be 
regarded, for if it is violent enough to endanger life, remedies must be 
pushed even beyond the point of tolerance. The writer once heard 
a celebrated physician cause much amusement among his auditors 
by detailing an instance of an epileptic who was getting well, and 
would have recovered if he had not died. His explanation was, that 
the man was syphilitic, and was receiving moderate doses of iodide 
and bromide of potassium, which were slowly benefiting him, and 
would have cured him had not a single severe fit produced death in 
the meanwhile. 

Another point to be considered is the condition of the digestion, 
which the bromide of potassium is peculiarly liable to disorder, and 
which is sometimes so disturbed as to necessitate the administra- 
tion of the drug by the rectum in serious cases. Females generally 
require smaller doses than males, and children of both sexes do not 
require as large quantities as adults. The dose to be used in the 
beginning of the treatment in moderate cases is about 10 grains 
(0.60) thrice a day; and while this may seem a very small quantity, 
it will be found that it can be rapidly increased in amount without 
causing the gastric distress produced by the sudden use of larger 
doses. Each day an additional 10 grains may be added, until at the 
end of a week the patient is taking 80 grains (5.3) in each twenty- 
four hours. There are very few cases which will not become 
saturated with the drug if this is done, and there are very few in 
which a more rapid arrival at bromism is needed. If, however, the 
patient has become able to stand large amounts by the prolonged use 
of the drug, the amount given is not to be governed by grains, but by 
physiological effects, and it may be pushed to any amount which is 
borne without distress. 

Full doses of the bromides, particularly in epileptics of an advanced 
type, sometimes cause maniacal outbursts in place of the epileptic 
attacks. In other instances the patients become morose and homi- 
cidal. (See article by author in Therapeutic Gazette, June, 1897.) 
Cases are on record in which the persistent use of large doses of 
the bromides has resulted in bronchitis with profuse and dangerous 
exudation, causing suffocative bronchitis. 



EPILEPSY. 651 

There is one more point to which attention must be called, and that 
is the fact that when the bromides are taken for any length of time 
they produce bromism, which in its moderate or severe forms pro- 
duces a mental condition closely allied to that seen in old, chronic 
epileptics. This condition of the mind should never be over- 
looked, and the ordinary mental changes of epilepsy are greatly 
aggravated by its constant and careless administration. (See Bromide 
of Potassium.) 

Recently European physicians have endeavored to aid the rapid 
saturation of patients by the bromides by depriving them of common 
salt, thereby causing the salt-starved system to absorb greedily the 
bromide of sodium. It is doubtful if this plan is justifiable. 

In chronic epilepsy, with regularly recurring fits, the greatest good 
is obtained by pushing the drug in ascending doses for one week, 
and then for the succeeding week only enough is given to preserve 
the general effects of the medicament. By doing this the stomach 
gets a rest and the appetite is not greatly interfered with. For 
obvious reasons where the attacks occur only every two weeks this 
is a particularly useful method. 

As regards the time of day when the drug is to be taken, there 
can be no doubt. Some writers have directed that it shall always 
be taken before meals, but this is entirely lacking in advantage and 
decidedly fruitful of harm. Drugs which are given with the object 
of affecting the general system should be taken after meals, not before, 
and it is only when a local gastric effect is desired that they should 
be given on an empty stomach, particularly when the substance is so 
depressing as a salt of potassium. If taken after meals, the appe- 
tite is not decreased, but there are few who can take a dose of 10 or 
20 grains (0.60-1.3) of bromide of potassium before breakfast without 
suffering from indigestion. 

If the attacks have a distinct periodicity, which is rare, or can be 
foretold for as long as two hours beforehand, the remedy may be 
taken in a large dose only at this time, and but a few grains given in 
the intervals; and if the attacks are severe, the physician should not 
hesitate to use large doses by the mouth and by the rectum on the 
day of the attack. 

It has been held by some that the drug should be taken in minute 
doses, frequently repeated, in order to keep the patient constantly 
under its influence. This is an example of therapeutic ignorance, 
because the bromides are slowly eliminated, and this frequent admin- 
istration possesses the disadvantages of being inconvenient, annoying, 
and apt to disorder the stomach. 

A very important point to be borne in mind is that the drug often 
seems to have produced almost a cure, and this results in carelessness 
in the regularity of administration. The patient should be impressed 
by the fact that every day passed without a fit is a step forward, and 
that every fit carries him many steps backward. He should also be 



652 DISEASES. 

directed to use the drug, in moderation, for at least three years after 
all fits hate ceased, and to watch after that time for the slightest sign 
of their return. The quantity taken each day should be gradually 
decreased, not suddenly stopped. 

Before passing on to the discussion of the employment of the other 
bromides, and the conditions produced by the excessive dosage of all 
of them, we may place our use of these compounds in epilepsy on a 
scientific footing. It is now generally recognized that the seizures 
known as epilepsy arise from the cells in the cerebral cortex, and 
there can be no doubt that the bromides act very powerfully upon 
the cerebrum in the higher animals, decreasing the irritability of 
the motor centres in these regions to a very great extent. Not only 
is this pointed to by clinical facts, but the researches of Albertoni 
prove beyond all doubt that such is their action. This investigator 
found that the administration of a single dose of the bromide of potas- 
sium so lessened the excitability of the motor cells in the cortex cerebri 
that much stronger stimulation was necessary in order to cause response 
in the limbs than was normal, and that it was difficult to produce 
epileptic attacks by means of electrical stimulation of the motor areas 
even when currents were used very much stronger than those which 
commonly produce such a result. He also found that this lessened 
irritability was increased still further if the drug was given for several 
days beforehand in such doses as thoroughly to impress the organism. 
It is therefore evident that the bromides act directly on the cortical 
areas, calming the tendency to explosions of nerve-force. 

The bromides of gold, iron, lithium, nickel, and ammonium have 
all been used in epilepsy with good results, but, except in certain in- 
stances, they fail to act as well as those of strontium, sodium, and 
potassium, unless given in larger doses. Bromide of sodium and of 
strontium are not by any means so apt to disorder the stomach, and 
are preferable in some cases on this account. They possess no other 
advantage. 

The bromide of ammonium is quite irritant and disorders the 
stomach very readily. It ought always to be used, when used at all, 
with other salts, the ammonium salt acting only as an adjuvant. 

Several clinicians have tried hydrobromic acid, but it is very much 
more apt to derange digestion and to produce vomiting than any of 
the salts. The dose of the dilute acid is \ to 3 drachms (2.0-12.0) in a 
tumblerful of sweetened water. 

There can be no doubt that in some instances what is known 
as the mixed treatment is very useful. This consists most commonly 
of a prescription in which the bromides of potassium, sodium, and 
ammonium take part. Why this combination acts better than any 
one of the salts alone is unknown, but it is certainly a clinical 
fact. 

Bechterew has recommended the joint use of the bromides with 
adonis vernalis in epilepsy as follows: 



EPILEPSY. 653 

1$ — Potassii bromidi 3iij (12.0). 

Infus. adonis vernal f§iv (120.0).. 

Aquce destillat q. s. fgvj (180.0).— M. 

S. — A dessertspoonful three times a day. 

Sometimes codeine is combined with this prescription. 

Within the last few years it has been claimed by Flechsig that the 
use of opium for a long period of time is useful in the treatment of 
epilepsy. He gives the opium in ascending doses during a period of 
six weeks, beginning with J grain (0.015) three times a day, and going 
as high as 5 grains (0.30) three times a day. This method decreases 
the frequency and severity of the fits for several months in some cases, 
but does not cause a cure. It succeeds best in old cases and is not 
useful in recent ones. 

In still other cases digitalis, when used along with one of the bro- 
mides, seems to produce favorable results. Indeed, digitalis has for 
years been used alone in epilepsy with fairly good results, and should 
always be used in obstinate cases. In petit mat, in which bromide 
of potassium when used alone so often fails, it is useful, and several 
English writers, notably Gowers, assert that its best effects are seen in 
cases of nocturnal epilepsy. Why this is the case no one knows, 
and it would seem doubtful whether it is more beneficial in nocturnal 
attacks than in others. 

Another combination very much employed and lauded is bromide 
of potassium with belladonna, the mydriatic being almost useless 
alone, although of great antiquity in its use in epilepsy. Like the mix- 
ture of digitalis and bromide, it succeeds very frequently in petit mal, 
and, indeed, seems to be much more successful than the digitalis, but 
its mode of action is exceedingly doubtful. As the drug acts even 
more powerfully upon the nervous system than upon the circulatory 
apparatus, it has been thought that its influence for good depended 
upon this effect, but the experiments of Seppilli contradict this belief, 
for he found that if atropine was given to an animal the surface of the 
cortex cerebri responded more readily than is normal to electrical 
stimulation. At one time it was held that belladonna acted on the 
spinal cord and peripheral nerves under such circumstances, but it 
should be remembered that we now know that atropine is only of value 
in relaxing spasm when given in full dose, oftentimes hypodermieally, 
and that Albertoni has made a series of experiments to determine 
whether it irritates the motor centres of the cortex. In his hands 
repeated small doses or one large dose in no way retarded the con- 
vulsions commonly produced by stimulation of the brain. Both these 
investigators are therefore in accord. Under these circumstances 
it affects rather the motor nerve-endings than the central nervous 
apparatus. 

Nitrate of silver was brought into use long before the value of 
more recent drugs was known. Every one is agreed that it is without 
power for good. As the drug is eliminated very slowly, it rapidly 



654 DISEASES. 

accumulates in the body, and argyria soon comes on. It may be used, 
after all else fails, in doses of J to J grain (0.01-0.15) thrice a day after 
meals, the mucous membrane of the inside of the lips and the con- 
junctiva being carefully watched for the early signs of chronic silver- 
poisoning. We certainly have no knowledge as to its influence on the 
nervous system; and if it acts at all, it must be by some alterative 
influence rather than by any other means. 

Nitroglycerin is to be employed in the treatment of petit mal, rather 
than haut mal, in the dose of 1 minim (0.05) of a 1 per cent, solution, 
once, twice, or three times a day. Our knowledge of its effects, so 
far as its curative influences are concerned, is very slight, but it seems 
to benefit some cases. Its action is fleeting, and it influences the 
brain but slightly, except it be taken just before an attack is expected 
or when the cardiac action is defective. 

The use of the nitrite of amyl is not for the purpose of directly 
curing the disease, but of warding off impending attacks, the warning 
of which is given by an aura of slow progression. It increases the 
severity of petit mal, but in epileptics who have a prolonged aura 
nitrite-of-amyl pearls, which are small glass beads containing a few 
drops of the drug, may be used. As the aura comes on the patient 
should break one of these in a handkerchief and inhale the drug, 
thereby putting aside the attack. The influence which the drug exerts 
upon the brain is secondary rather than primary, and is probably 
dependent on its action on the blood or circulation. Its influence on 
the spinal cord and nerves is much more marked and direct, and it 
is most certainly a very powerful spinal depressant. Nitrite of amyl 
puts aside an attack by a sudden shock to the nerve-centres, which 
diverts them, so to speak, from their intended discharge, very much 
as a ligature around the arm stops an aura. When we remember 
that the drug acts instantly and converts nearly all the oxygenating 
blood of the body into a non-oxygen-carrying fluid by reason of the 
methsemoglobin produced, the sudden change in the cerebral nutrition 
and state is easily understood. 

In the treatment of the "status epilepticus" nitrite of amyl is of 
great value in checking the seizures, and may be used under these 
circumstances in heroic amounts, applied to the nostrils at intervals. 
During the presence of the tonic spasm, if it be severe enough to 
suspend respiration, it should be remembered that if the drug is not 
inhaled it is worthless. It is only when respiration is being carried 
on that it can enter the lungs and do its work. The nitrite of ammo- 
nium or of sodium or nitroglycerin should be used internally to 
supplement the nitrite of amyl. Another valued method in treating 
the status epilepticus is free bloodletting. 

The use of anaesthetics during an attack of epilepsy is virtually 
useless, and in some cases dangerous, for ether is too slow in its effects, 
and may, by its irritant vapors, increase the tendency to laryngeal 
spasm or cause lung complications. Further than this, if uraemia is 



EPILEPSY. 655 

the cause of the fit — and this fact is unknown in every case when it 
is seen for the first time until the individual is carefully examined — 
the ether may further irritate the kidneys. 

Chloroform, though it acts much more rapidly, may cause sudden 
cardiac failure, and both drugs may increase the post-convulsive coma 
very greatly. In status epilepticus they may be used, as in such 
cases the convulsions must be stopped at all hazards, but the preference 
should be always for amyl nitrite. 

The iodide of potassium is useless in epilepsy unless the disease 
is due to syphilis, when it is of the greatest service. Indeed, the 
bromide and all other drugs should be discarded while this one 
is pushed to the utmost. As is well known, syphilitics usually 
bear the drug extremely well, and the author knows of one instance 
where no less than 800 grains (53.0) were taken every twenty-four 
hours, with rapid improvement as a result. This point is strongly 
insisted upon by all therapeutists and syphilographers, notably 
Fournier. 

Where the convulsions are due to the presence of a gumma, how- 
ever, the iodide of potassium is too slow in its action, and should be 
associated with mercury in order to break down the growth without 
delay, lest a seizure cause death by glottic closure, producing asphyxia 
or some similar accident. 

Chloral possesses the disadvantage, as compared with the bromides, 
of being a very fatal poison, which is an important fact to be borne 
in mind by the physician when giving it to a patient whose mind is 
already weakened by the disease or who is naturally stupid, and who 
may forget the dose and take too much. Its physiological action indi- 
cates much more fully that it may be of .value than does that of many 
other more lauded remedies, since it exerts its chief influence on the 
motor pathways of the spinal cord and quiets the motor portion of 
the cerebral cortex, and so produces sleep. Seppilli has proved this 
by direct experimentation after the method employed by Albertoni. 
Its use, combined with one of the bromides, is often followed by 
the most desirable results, and it should be tried at all times unless 
some cardiac complication forbids it. It may disorder the stomach, 
and should, like the bromides, always be given well diluted and after 
meals. 

Of the more recent remedies, acetanilid stands in the foremost 
rank, and bids fair in some instances to rival the bromides. Ger- 
main-See, the author, and some others have reported cases which 
obtained marked relief from it, and more recent investigators have 
done likewise. The drug will be found to exert its beneficial effect 
chiefly in chronic epilepsy. 

Antipyrin has been recommended by Lemoine in certain forms of 
epilepsy, but it has been condemned by other clinicians. He found 
it very useful in cases associated with migraine. In these cases the 
results were better than with the bromides, but in the idiopathic simple 



656 DISEASES. 

varieties it was useless. Mairet and Combemale have used the drug 
in epileptiform mania with satisfactory results. 

In the epilepsy of childhood Solanum Carolinense in the form of 
the fluid extract, in the dose of 2 to 15 minims (0.1-1.0 c.c.), is some- 
times a useful drug. 

The value of the treatment of epilepsy by borax has not received 
very wide recognition. Perhaps the most thorough studies of its effects 
have been those of Gowers in England and Folsom in America. It 
would seem that some cases which are obstinate under ordinary treat- 
ment are benefited by borax, but it is certainly not to be commonly 
employed. The dose generally given is about 15 grains (1.0). (See 
Borax.) 

In children who have single convulsive attacks the presence of 
worms should always be looked for, and when found they should 
be expelled as rapidly as possible. If they are oxyuris vermicular is 
(seat- worms), the best remedy by far is the injection of an infusion of 
quassia of such a strength that there are 2 ounces (60.0) of quassia 
in each pint (480 c.c.) of water. 

In girls, where the removal of the worms from the rectum is not 
followed by relief, a careful examination of the vagina should be 
made, and quassia employed in somewhat weaker solution, as very 
commonly intense inflammation is there present, produced by migra- 
tion of rectal parasites. If the quassia is unobtainable in any case, a 
saturated solution of chloride of sodium may be employed. 

A very important point, which is constantly brought before the 
physician who is treating epilepsy, is that of diet. Nearly every 
patient who suffers from this disease inquires what he shall eat. Few 
researches of a thorough character have been carried out on a large 
scale to determine what may or may not be ingested. Curiously 
enough, the influence of diet in one research covering a number of 
cases of chronic epilepsy seemed to be of little moment. Thus, 
Merson examined 24 such cases, putting 12 of them on a purely 
vegetable, and 12 on a purely nitrogenous, diet. The result, after 
this study had been continued for two months, was that the vege- 
tarians had had a few less fits than the others, but the difference 
was so slight as to be of almost no weight in determining the question. 
The view that meats are harmful is erroneous. 

EPISCLERITIS. 

Episcleritis, or inflammation of the episcleral tissue, manifests itself 
in the form of dusky-red, subconjunctival swellings, over which the 
conjunctival vessels are coarsely injected and the surrounding con- 
junctiva cedematous, and which usually appear in the ciliary region 
on the temporal side of the cornea. Occasionally the inflammation is 
diffuse and the injection bluish red in color. This disease may be 
due to rheumatism, gout, scrofula, and menstrual derangements, is 



EPISTAXIS. 657 

very prone to relapse, and sometimes stubbornly resists treatment. 
This, in addition to atropine locally and mild antiseptic collyria, should 
include the internal administration of remedies indicated by the under- 
lying constitutional cause, particularly the salicylates, iodide of potas- 
sium, jaborandi-diaphoresis, etc. Naturally, menstrual and uterine 
disorders must be rectified. A peculiar variety of episcleritis, known 
abroad as periodic fugacious episcleritis, and in England as " hot eye," 
but in this country as vasomotor dilatation of the vessels, appears in 
the form of patches of episcleral injection or oedema of violaceous 
hue, lasting from two to eight days and reappearing at intervals of 
several weeks, or even months. Almost always gout and rheumatism 
are the associated dyscrasias, and suitable constitutional remedies 
must be exhibited. 

EPISTAXIS. 

Nose-bleed depends upon many causes, the chief of which are 
traumatisms, plethora, and the presence of ulcerations in the nasal 
chambers. It also occurs as one of the prodromata of typhoid fever 
and in some cases of cardiac valvular disease. 

The measures to be adopted for its control are both medicinal and 
non-medicinal. If the individual is full-blooded and strong, full doses 
of tincture of aconite or veratrum are useful, say 5 to 10 minims 
CO. 30-0.60) of one of them, followed in a half-hour by a smaller dose, 
if necessary. The value of these drugs depends upon their power of 
lowering blood-pressure, and in consequence decreasing the leakage 
from the break in the wall of the bloodvessel. Some physicians have 
recommended ipecac in full nauseating doses to relax the arterial 
system. Sometimes, when the oozing is slow, turpentine, oil of erigeron, 
or hamamelis, taken internally, does good. In the way of local treatment 
by far the best application, because it is efficacious and yet harmless, is 
adrenalin chloride in salt solution 1 : 10000, which should be placed in 
the nasal chambers on a piece of cotton, or if it cannot be obtained 
powdered alum, pure or half and half with starch, or alum in solution, 
may be snuffed up the nostril, or tannic acid, in powder or in solution, 
may be used with advantage. If this does not control the hemorrhage, 
an atomized spray of Monsel's solution, in the strength of 5 minims 
to the ounce (0.3-30.0) of water, may be of service. 

The non-medicinal measures to be employed if the bleeding is 
severe consist in plugging the anterior nares with pledgets of cotton 
or pieces of lint soaked in adrenalin solution or vinegar. If this does 
not control the hemorrhage, the posterior nares may also be closed 
by plugs, and compression of the facial artery of the same side as the 
bleeding nostril be made upon the superior maxilla near the nose, 
thus decreasing the blood-supply. The head must be kept raised, and 
the patient must not bend over a basin or wear a tight collar. 

A piece of bacon fat cut to fit and placed in the nostril may stop 
epistaxis which has resisted other measures. 

42 



658 DISEASES. 

As a household remedy diluted vinegar may be injected into the 
nostrils, or lemon-juice may be employed in the same way. 

Sometimes, if the patient raises one or both hands high above the 
head, the hemorrhage ceases. This is due to the fact that the easiest 
pathway for most of the blood is straight up the brachial arteries 
rather than through the tortuous vessels of the face. A hot foot-bath, 
by dilating the veins of the lower extremities, draws away the blood 
from the face and is a useful measure ; but if bleeding has been profuse, 
this may cause the patient to faint unless he lies down when his feet 
are in the water. In other cases a hot-water bag applied over the 
dorsal vertebra? is efficacious, and sometimes cold when so used is of 
service. A piece of ice pressed against the nose may prevent further 
hemorrhage by causing localized anaemia. 

Where the nasal hemorrhage results from traumatism with fracture 
of the bones, and great loss of blood ensues, compression of the bleeding 
vessel or its supplying vessel should be made if possible. 

ERYSIPELAS. 

This disease is now generally recognized as dependent for its exist- 
ence upon a germ. The streptococcus of erysipelas is practically 
identical with that of pus, and the disease is at first a distinctly local 
one. The changes which have taken place in its treatment are chiefly 
the local measures, while those methods which have been used internally 
for many years have undergone no alteration. 

In a large proportion of cases erysipelas develops because the vital 
resistance of the patient has been lowered by some acute illness or by 
a chronic malady like nephritis or diabetes. For this reason its spread 
in the skin and the toxaemia it causes must be controlled by the em- 
ployment of every measure that will enable the patient to combat 
the infection. Rest in bed is essential and supporting treatment 
is demanded. J. M. Da Costa recommended, and others have car- 
ried out with success, the practice of using pilocarpine in sweating 
dose (-§- to \ grain) hypodermically in these early stages. (See Pilo- 
carpus.) It is to be remembered that this use of pilocarpine is not to 
be resorted to if debility exists. 

The internal treatment of erysipelas par excellence is the plentiful 
use of the tincture of the chloride of iron — 20 to 30 minims (1.3-2.0), 
or even 40 minims (2.60), well diluted, four times a day. The diet 
should be regulated and the bowels kept in good order. Any excessive 
febrile movement is to be treated by the use of cool sponging with 
friction. Where the patient passes into the typhoid state supportive 
measures must be used and alcoholic stimulants added to the food, 
which should be predigested or prepared so as to be readily absorbed. 

During convalescence the use of tonics, both in the form of iron 
and of bitters, is particularly indicated if recovery of strength is 
slow. 



EYE-STRAIN. 659 

The local treatment of erysipelas is very varied, but in the majority 
of cases resort need be had to but one method. By far the best 
dressing for the majority of cases of erysipelas is a modification of 
that of von Nussbaum, which the author has tried in a great num- 
ber of instances with success. The skin of the part involved is care- 
fully cleansed with Castile soap of the purest form, and then it is 
washed off with a 1:1000 solution of bichloride of mercury. The 
skin is dried with a soft towel, and a thick coating of ichthyol with 
vaselin or lanolin applied, the strength of this ointment being half 
and half. Over this is placed antiseptic gauze or sterilized absorbent 
cotton, and adhesive strips or a bandage is used to keep the dressing in 
place. Sometimes the ointment alone may be applied if the area is 
small. Under this treatment the results are often extraordinary in all 
stages of the malady. Where ichthyol is not obtainable, a thick coat 
of white-lead paint, as it is sold in cans before it is mixed with any 
thinning substance, will be found of service in an emergency. 

The iron and ichthyol method is that always followed by the 
author. 

The plan recommended by Higginbottom, of applying nitrate of 
silver, is sometimes successful. It consists in the use of a solution 
of the strength of 80 grains to 4 drachms (5.3-16.0) of distilled water, 
which is thoroughly applied with a earner s-hair brush over the entire 
inflamed area and for a little space beyond. The application must be 
made twice or thrice to secure a good coating. This treatment will 
often arrest the inflammation and prevent its spread, but has caused 
sloughing; the author has never used it. 

EYE-STRAIN. 

Eye-strain, in the broadest acceptation of the term, is the name 
applied to those symptoms which may be caused by the presence of 
refractive error, or imbalance of the ocular muscles. While all varie- 
ties of ametropia may cause eye-strain, hypermetropia and astigmatism 
are most potent in this respect. Fully 60 per cent, of functional head- 
aches are caused by refractive errors; and these headaches may vary 
from a moderate frontal distress to violent explosions of pain, and may 
be situated in any portion of the cranium. Moreover, they may be 
entirely unassociated with any pain in the eyes or any apparent dis- 
turbance of vision, and are frequently caused by low degrees of refrac- 
tive error; in fact, they are perhaps more frequently caused by them 
than by the higher defects. In addition to headache, eye-strain may 
cause pain in the back, especially between the shoulder-blades and at 
the root of the neck, precordial pain, vertigo, drowsiness, insomnia, 
habit-chorea, choreiform movements, convulsive seizures, melancholia, 
neurasthenia, palpitation of the heart, night-terrors, stomachic dis- 
turbances, flatulent dyspepsia, and a variety of general or so-called 
reflex neuroses. The existence of any of these symptoms or affections 



660 DISEASES. 

should direct the attention of the attending physician to the condition 
of the eyes, and refractive error and muscular imbalance should be 
corrected. 

EXHAUSTION AND DEPRESSION. 

While the treatment of both these conditions is almost identical in 
some respects, it is nevertheless important that a clear idea of the 
difference between the two be clearly understood, if for no other 
reason than that the physician may recognize that exhaustion is a 
far more serious state than depression. It also requires more careful 
treatment. The man who is depressed retains in his body all the 
vital forces necessary for the maintenance of life, but they are tem- 
porarily in abeyance from some cause. As soon as the incubus is 
taken away the system at once asserts itself and recovery takes place. 
This is not the case with a man suffering from exhaustion. In this 
patient every particle of his strength is sapped and lost. The man 
depressed is the giant lying unconscious from a blow on the head; 
the man exhausted is the same giant after a long attack of typhoid 
or other fever of a similar nature. The treatment of depression is 
stimulation; of exhaustion, not only stimulation, but rest, feeding, and 
protection from exposure. 

FEET SWOLLEN, TENDER, OR SWEATING. 

These comparatively simple yet annoying conditions are often 
brought before the physician for relief, and patients suffering from 
them will frequently be more grateful for skilful treatment than in 
the event of recovery from a severe illness. 

Swelling of the feet occurs chiefly in two classes of cases, excepting, 
of course, dropsy. The two classes named are old persons taking too 
little or too much exercise, and who may have gouty or rheumatic 
tendencies, and those who by constant standing or walking cause 
congestion of the lower extremities, chiefly by fatigue, or by wearing 
bad shoes, or by running over uneven ground, causing bruising. Where 
the swelling takes place in the first class, small doses of arsenous acid, 
-bV to To" g ram (0.001-0.0015), often do good, and careful examination 
should be made of the circulatory, renal, and respiratory apparatus 
to discover any weak points, such as vascular relaxation or tendencies 
to varicosities. The distilled or fluid extract of hamamelis is often 
of service in the dose of \ to 1 drachm (2.0-4.0) of the former and 10 to 
20 minims (0.60-1.3) of the latter preparation. In some cases absolute 
rest of the feet will be necessary before a cure is reached. 

Where the feet are tender the most common cause is bruising from 
too thin soles on the shoes, too tight shoes, and from abrasions or skin 
disease. More commonly than all they become sore from excessive 
sweating and resulting maceration. 

The treatment of sweating and tender feet is, of course, the removal 



FEVER, AND ITS TREATMENT. ^\ 

of the cause and the use of remedies designed to toughen and harden 
the skin of the parts. Probably the best application for this purpose 
is a solution of salicylic acid and borax, half and half, in water and 
glycerin, rubbed over the feet night and morning. If the sweating is 
very profuse, clean stockings should be worn each day, the stockings 
being previously soaked in a strong solution of borax and dried. The 
following prescription affords a useful powder: 

ty — Pulv. acidi salicylici gr. xx.vel xl (1.3-2.60). 

Pulv. acidi borici 5ij (8.0). 

Pulv. amyli q. s. ad . gj (30.0).— M. 

S. — To be dusted over the feet night and morning, after washing and thor- 
oughly drying them. 

One of the most efficient applications is a solution of formaldehyde 
of such strength that 1 part of the commercial 37 per cent, solution 
is mixed with 4 parts of water. Even this may be too strong in some 
cases. A more agreeable application is diluted euformol. 

Sometimes the use of cotton instead of woollen stockings may aid 
in the cure. 

FEVER, AND ITS TREATMENT. 

(For the Treatment of each Fever, see its Title.) 

At the present time the medical profession is universally of the 
opinion that fever is a disorder of calorification dependent upon 
nervous action, said nervous action being the result of various causes, 
such as the presence of poisonous materials in the blood causing per- 
verted functional activity of the heat centres. The rule of practice 
should be to control all fevers by the use of cold sponging or bathing 
and to resort to antipyretic drugs as little as possible. 

Antipyretics may be divided into three great classes : first, the sub- 
stances which allay or prevent fever by inhibiting its production; 
second, the drugs which possess the power of decreasing bodily 
temperature by increasing the dissipation and decreasing the pro- 
duction of heat; and third, the compounds which allay fever, not by 
stopping the manufacture of heat-units, but by so increasing the dissi- 
pation of heat that the loss is greater than the manufacture. The first 
and last of these classes are directly opposed to one another. The 
second class is half-way between, and it is to this class that most of 
our antipyretic drugs belong. 

The objection to the use of all antipyretic drugs is that they depress 
the patient and decrease his power of resisting disease. 

The presence of a high temperature alone does not constitute the 
sole indication for treatment. The physician should be governed by 
the state of the patient who is laboring under the malady. A temper- 
ature of 106° F. in a young healthy man suffering from an attack of 
some disease of short duration does not mean very great danger, but a 
temperature of 103° F. day in and day out in typhoid fever does mean 



662 DISEASES. 

danger, chiefly because it is a gauge of the toxaemia, and must be care- 
fully attended to. The question is one not of actual degrees of Fahren- 
heit, but rather as to whether the state of the patient is toxic. 

We have only two measures for the relief of fever which are reliable. 
These are the employment of antipyretic drugs and the use of cold 
water. As already stated, drugs are to be used very rarely, but the 
beneficent effects of the use of cold water are extraordinary, and it 
should be freely employed if the fever is high. (For the mode of 
using acetanilid and antipyrin see pp. 53 and 90, and for the use of 
cold see p. 471.) 

The friends of the patient, if they are intelligent, can easily be 
taught how to use cold sponging with friction, and good results, far 
superior to those produced by antipyretic drugs, are thus obtained. 
The reasons for this are discussed farther on. The water should be 
as cold as is necessary to reduce the fever satisfactorily in twenty min- 
utes of sponging, and reaction must be produced by friction applied 
to the skin. This reaction is more important than the reduction of 
the fever. (See Cold in Fevers, Part III.) 

(For the use of guaiacol externally in fever, see article on Guaiacol.) 

Sthenic Fevers. 

The application of antipyretic drugs to the febrile temperatures 
occurring in sthenic cases is not so irrational as their employment in 
a prolonged low fever of the adynamic type, but the wise physician 
will always endeavor to avoid their use if possible. Fever is not, as a 
rule, a very harmful process unless it is continued for a long period 
or is exceptionally high. Indeed it may even be beneficial. Anti- 
pyretic drugs decrease oxidation, probably interfere with ordinary 
protective natural efforts against disease, and place upon the eliminat- 
ing organs the task of excretion. In acute illnesses, if the use of cold 
is impossible, these remedies may be given, but usually it is unnecessary 
to employ them, for unless the fever is long continued it is not harmful 
in itself. In scarlet fever the use of such drugs should be avoided, 
because the kidneys are in danger. 

If in any case it is decided to give antipyretic drugs, they should 
never be pushed to the point at which even moderate cyanosis develops ; 
and if they do not control the fever in moderate dose, they should be 
discarded and cold bathing insisted upon. The use of antipyretic 
drugs and cold sponging simultaneously is absolutely harmful. 

Personally the writer never under any circumstances employs anti- 
pyretic drugs for the reduction of fever. 

In thermic fever, or sunstroke, the employment of antipyretics is 
often useless. The excessively rapid upward rise of the temperature 
responds in no way to drugs, and there are many cases on record in 
which the use of antipyrin has utterly failed of good result. 



FRECKLES AND CHLOASMA. ^63 

Asthenic Fevers. 

{Fevers of a Typhoid Type.) 

In the opinion of the author antipyretics should not be employed 
in the reduction of the pyrexia of the typhoid state, our main reliance 
being upon cold applications. They ought never to be combined 
with the cold bath, as they prevent the one thing we seek in the use of 
the cold, namely, reaction. Aside from the fact that he has found 
such an opinion well founded in a large number of cases, logical reason- 
ing endorses its correctness. Even if antipyretics were perfectly 
innocuous, their constant use in fever would but give the already 
overstrained kidneys the task of their excretion, while the stomach, 
already disturbed by necessary medicines and illness, has enough 
to do without the addition of another load. Further than this, we 
know that these drugs are not perfectly harmless, and we also know 
that they decrease oxidation, which is not the case with the cold bath, 
which increases it. The writer reiterates that in typhoid and other low 
fevers of the continued type antipyretics should not be given. (For 
Brand's treatment, see Cold, Part III.) Fever will sometimes resist 
all doses of antipyretics we can give or all that it is safe to give, but no 
fever can completely resist the cold sponge when properly used, for by 
its use we produce beneficial results by reaction even if an actual fall of 
temperature does not take place. In septic fever and in tuberculosis 
antipyretics are harmful owing to the depression and the increased 
sweating which is apt to be produced. 

FRECKLES AND CHLOASMA. 

The removal of freckles is readily accomplished, but their return is 
inevitable if any exposure to the sun or wind occurs. One of the best 
applications for their removal is a solution of corrosive sublimate, in 
water, varying in strength from 1 to 4 grains to the ounce (0.06-0.25: 
30.0), and applied night and morning until the skin shows that it is 
irritated, when the lotion must be stopped for some days, after which 
its use may be begun again. A very efficient and much less poison- 
ous remedy to leave about the room is a saturated solution of boric 
acid in water, applied in the same manner as is the solution of 
bichloride of mercury. 

Another remedy is lactic acid, 10 grains to a drachm (0.60 : 4.0) of 
water, used in the same manner as the solution of the bichloride of 
mercury. The following prescription is recommended by Unna: 

1$ — Bismuth, oxidi, 

Pulv. amyli aa gr. xxx (2.0). 

Kaolini oj (4.0). 

Glycerini fo'ij (8.0). 

Aquae rosse q. s. ad f§ij (60.0). — M. 

S. — Paint on spots and allow to dry, washing the drug off before each new 
application. 



664 DISEASES. 



Or the following may be used: 

Jt£ — Zinci oxidi 

Hydrarg. ammoniati 
Ol. theobromat. . 
01. ri cirri .... 
Essent. rosae . 
S. — Apply night and morning 



GASTRALGIA 



gr. iij (0.2). 
gr. iss (0.08). 
f5ijss(10.0). 
f3ijss(10.0). 
gtt, x (0.60).— M. 



Before undertaking to treat a case of severe gastric pain, as one of 
gastralgia, the physician must determine the possible presence of gastric 
ulcer, gastric cancer, and the gastric crisis of locomotor ataxia. 

The treatment of gastralgia may be divided into two parts — that 
directed to the relief of the attack when it is present, and that devoted 
to the prevention of other attacks. During the acute stage hot appli- 
cations and drinks, aromatic and locally stimulating warm infusions, 
a few drops of chloroform, or brandy or whiskey with a little hot 
water, or 30 to 40 minims (2.0-2.60) of laudanum may be used. 
Counterirritation often does good, and in some cases, particularly if 
a suspicion of an hysterical element exists, a vigorous revulsive may act 
with surprising success. Emesis and purgation are sometimes indi- 
cated, since in the early attacks the cause of the pain may be suspected 
to be the presence of indigestible food. 

The treatment required in the intervals between the attacks must 
vary with the cause and with the general condition of health. A 
careful search must be made for the real cause of the trouble, and 
when found it must be removed or palliated by appropriate measures. 

The diet should be carefully regulated, and all the hygienic details 
of the patient's life be critically studied and directed. The avoidance 
of improper food, the abandonment of tea, coffee, and tobacco, the 
prescription of proper dress, exercise, or change of residence, may be 
followed by marked improvement in general health and by a cessation 
of the attacks of gastralgia. 

Any marked disturbance of digestion should be corrected; and this 
may require the use of pepsin or of some tonic remedies, such as are 
suggested in the article on Indigestion. The chief reliance, if anaemia is 
present, is to be placed upon the administration of arsenic and iron im- 
mediately after meals, in proper form and doses. Thus, we may direct: 

R — Liquor potassii arsenitis f^j (4.0). 

Vini ferri amari . . . . q. s. ad f Jiv (120.0). — M. 
S. — From 1 to 2 drachms (4.0-8.0) in water after meals, three times daily. 

Or, 

K — Tincturae ferri chloridi f^j (30.0). 

Acidi hydrochlorici diluti, 

Liquor acidi arsenosi aa. f^ss (16.0). — M. 

S. — From 4 to 15 minims (0.25-1.0) in water after meals, three times daily. 

Occasionally even better results are secured by the use of cod-l.ver oil 
in emulsion with the hypophosphites. 



GASTRIC CATARRH {ACUTE). 665 

When the pain in the epigastrium is due to an excessive secretion 
of hydrochloric acid the various bromides are of value, and should be 
given long enough before meals to permit them to produce their effects 
before the food enters the stomach. In other cases a pill of nitrate' 
of silver and hyoscyamus should be employed. (See Gastric Ulcer.) 

Chloretone is also useful in the dose of 5 to 10 grains (0.30-0.60) in 
capsule. It is well, in cases where the pain is very severe, to combine 
with the above a powder of bismuth subnitrate and pepsin, given 
after meals. 

Constipation must be overcome by proper diet, massage, enemata, 
or by suppositories of gluten or glycerin or soap. If the use of bismuth 
favors the continuance of constipation too decidedly, small doses of 
cyanide of potassium, dilute hydrocyanic acid, or chloroform may be 
substituted at the same hours. In cases where a highly neurotic state 
exists, it may be necessary to alternate all other treatment with the 
bromides or with the preparations of valerian, or the following pre- 
scription may be used: 

$— x<\cid. hydrocyanic, dil f gj (4.0). 

Fluidextract. cannab. indicae . . . . f gj (4.0). 

Tr. hyoscyami f'3iss(6.0). 

Spt. chloroformi f 3 i j (8.0). — M. 

S. — 30 minims (2.0) t. i. d. in water for an adult. 

GASTRIC CATARRH (ACUTE). 

By far the most important point in the treatment of acute gastric 
catarrh is the regulation of the diet. The dietetics may be divided 
into two parts — first, the regulation of the food during convalescence 
or during the attack; and, secondly, the character of the food to 
be used during the interval following one attack and preceding the 
next. Total abstinence from food in the acute stages of the attack, 
and absolute bodily and mental quietude, are advisable. There are 
several reasons for this. In the first place, the juices of the stomach 
are in an abnormal state and unfit to act properly if the stomach re- 
ceives more food. Secondly, the mucous membrane of the stomach is 
already hyperoemic from the inflammation, and, as the normal viscus 
becomes physiologically hyperaemic on the ingestion of food, we 
would add to the congestion of the bloodvessels did we allow more 
nourishment to enter the stomach. Last of all, the excess of the 
mucus and lactic and butyric acids present renders any new food 
impure before it can be assimilated, and so prolongs the trouble. 
As the attack passes off small amounts of food may be given, which 
should be of a kind readily digested and not likely to become easily 
decomposed or rendered acrid by the mucus in the stomach. Milk 
with a large percentage of lime-water is to be used, since the alkali 
not only prevents a too firm coagulation, but also decreases the secre- 
tion and acid reaction of the mucus. The thirst is often excessive, 
although anorexia is complete, and small pieces of ice may be admin- 



66Q DISEASES. 

istered for its relief. Small doses of bismuth subnitrate (grains 2 
[0.12]) and of cerium oxalate (grain 1 [0.06]) every two hours are 
advisable. 

Commonly it will be found that the patient rapidly improves up to 
a certain point, then stops improving or relapses. This is sometimes 
due to an accumulation of mucus, which when mixed with food 
causes it to undergo fermentation. If marked evidences of the 
presence of this secretion are given, a mild and gently acting purge, 
such as calcined magnesia, followed by a little orange juice, may be 
employed to dislodge the fermenting mass. In other instances the 
relapses depend upon a tendency to a condition of atony, which can 
only be overcome by prolonged and careful treatment adapted to the 
improvement of the general health. Sodium bicarbonate with com- 
pound infusion or compound tincture of gentian may be used during 
convalescence, and small sips of effervescing draughts are useful. If 
constipation exists and vomiting forbids the use of the ordinary purga- 
tives, a Seidlitz powder divided into fourths or fifths, and taken in 
this way every fifteen minutes or half-hour, will settle the stomach, 
move the bowels, and often carry away mucus. 

If there is much epigastric distress, a spice or mustard poultice 
is often of service. 

Sweets and starches are to be rigidly denied the patient. If anae- 
mia exists, iron may be used, but this is rarely needed. 

The abdomen should be carefully protected with flannel, and 
draughts and unsanitary surroundings avoided. 

GASTRIC CATARRH (CHRONIC). 

Chronic gastric catarrh is a condition of the stomach commonly seen 
in a more or less well-developed form. It is often associated with 
much indigestion and the eructation of sour liquids, or even with 
active vomiting. The secretions of the stomach are nearly always 
abnormal, and fermentative changes are constantly present in the 
gastric contents. Lavage is almost always to be resorted to for its 
relief. (See Lavage, Part III.) 

By far the best treatment for this condition is the use of counter- 
irritation over the epigastrium by means of tincture of iodine, the strict 
regulation of the diet, and the use, internally, of nitrate of silver and 
extract of hyoscyamus, and, if great hyperacidity exists, the admin- 
istration of the subnitrate of bismuth. Often, however, the better 
remedy is bicarbonate of sodium in the dose of 5 to 20 grains (0.30- 
1.3). In many instances the patient will be greatly benefited by the 
use of a Seidlitz powder or Carlsbad salt 1 or Hunyadi or Apenta water 
before breakfast each morning, as this washes out the stomach, dis- 

1 Artificial Carlsbad salt may be ordered, composed of 8 ounces of sodium sulphate, X A 
ounce of sodium chloride, and 1 ounce of sodium carbonate. The dose varies from 2 drachms 
to Yi ounce (8.0-16.0). 



GASTRIC DILATATION. QQ*j 

solves the mucus, and unloads the mucous membrane of its congestion, 
at the same time overcoming any engorgement of the liver. The 
efficiency of these purgatives may be increased by using hot water. 
Constipation is nearly always present, and should be relieved by appro- 
priate drugs, such as the waters just named or cascara sagrada, of 
which the best preparation is the fluid extract, rendered free from 
bitter taste, as in "Cascara Aromatic." 

All fats, rich foods, strong meats, ham, bacon, and fried foods are 
to be avoided, and only light broths, koumyss, or matzoon resorted 
to if the case be an obstinate or severe one. A nitrate-of-silver pill 
should be used half an hour before each meal, and be prescribed as 
follows : 

R — Argenti nitratis . . gr. iv (0.25). 

Extract, hyoscyami gr. x (0.60). — M. 

Ft. in pil. No. xx. 

S. — One pill half to one hour before each meal. 

In cases in which the chronic inflammatory process has gone on to 
atrophy of the tubules the use of hydrochloric acid is often of great 
value. (For formula, see Hydrochloric Acid.) 



GASTRIC DILATATION. 

Gastric dilatation is to be treated with two objects in view, namely, 
the relief of the symptoms and the correction of the gastric condition 
as far as possible. The relief of the symptoms depends upon the suit- 
able regulation of the diet, the proper use of washing out the stomach 
(lavage), and the use of other remedial measures. All these efforts 
also tend to relieve or modify the underlying gastric state in that 
they remove certain influences which, if continued, would necessarily 
make the condition of the patient worse. The actual state of dilatation 
when once developed cannot be materially improved. In the way of 
diet, all articles bulky in character, such as cabbage, and those foods 
which are slow of digestion and capable of rapid fermentation should 
be excluded. Particularly is this true of rich or fatty foods, and of 
drinks such as beer and ale. When food is given, it is to be admin- 
istered in small amounts and often, rather than in large, full meals, and 
it should consist chiefly of roasted and broiled meats, easily digested 
starches, such as "Zweibach" bread or "pulled bread," and the 
green vegetables, like lettuce, asparagus, string beans, and moderate 
amounts of spinach. To aid in the digestion of vegetable foods 2 to 
4 grains (0.12-0.25) of taka-diastase should be taken with each meal, 
and to this may be added a little powdered capsicum to stimulate the 
stomach. Where gastric digestion is very faulty, predigested food 
and rectal alimentation should be employed for a time. In the way 
of direct treatment, the stomach of the patient should be washed out 
with the stomach-tube at least once a day; and if fermentation is 
active and food is apt to be retained in this organ, it should be thor- 



QQS DISEASES. 

oughly cleansed before each meal, and some mild antiseptic, like 
boric acid, used in the washing fluid. Lavage not only removes 
decomposing food and mucus, but also exercises a beneficial effect on 
the gastric walls. The water used should not be cold nor tepid, but 
hot, and may contain 1 drachm (4.0) of boric acid to the pint (480 c.c). 
Faradic electricity applied to the epigastrium or to the stomach direct 
by a swallowed electrode is useful. In the way of direct treatment 
by drugs, the physician should use full doses of dilute hydrochloric 
acid to aid digestion, say, 20 to 30 minims (1.3-2.0), and give strychnine 
in full doses to aid this function, and also to increase the motor power 
of the stomach, so that it will urge the food on into the bowel. Often 
the lavage, electricity, and strychnine combined will produce great 
improvement. General hydrotherapy in the form of cold douches 
to the entire body, and exercise on horseback or on foot, are valuable 
in many cases. If fermentation is marked, antiseptic substances, 
like beta-naphtol, may be employed internally. 

GASTRIC ULCER. 

In the treatment of gastric ulcer three points must be borne in 
mind as being essential. These are, rest for the stomach as far as 
possible, rest for the patient, and the maintenance of the general 
health. The first of these points involves a consideration of diet. 
If in any case the stomach is very irritable, it is best to place the 
patient in bed and nourish her for from two to eight days by means 
of enemata. Probably the best form of nourishment for this purpose 
is a mixture recommended by Dreschfeld, and consisting of 2 raw 
eggs with 2 ounces (60.0) of beef-tea and a little brandy, which may 
amount to 1 ounce (30.0) if the patient really needs stimulants. It 
may be well to place a little pancreatin in this injection to peptonize the 
proteids, but if this is done the alcohol must be left out, as it will 
interfere with the activity of the pancreatin. Ewald of Berlin suggests 
the following nutrient enema: Beat up 2 eggs with a tablespoonful 
of cold water; to this add a little starch boiled in half a cupful of a 
20 per cent, solution of grape-sugar, and a wineglassful of red wine. 
The solution is to be well mixed at a temperature not high enough to 
coagulate the albumin, and injected as high up into the bowel as 
possible. For a child this mixture should be somewhat less in quantity 
than that given for an adult, particularly as to the wine. For the 
relief of thirst, which may be excessive if rectal alimentation is resorted 
to, the patient may hold in the mouth small pieces of ice or drink 
moderate quantities of cool barley- or rice-water; but much thirst can 
be prevented by resorting to hypodermoclysis, whereby the body is 
supplied with plenty of fluid. (See Part III.) After this treatment 
has been used for some days, small quantities of food may be given 
by the mouth, such as a little peptonized milk or a little warm milk 
with lime-water in the proportion of half and half, or 1 part of lime- 



GASTRIC ULCER. QQ$ 

water to 2 of milk. After this, thin arrow-root or gruel may be given 
in moderate quantity, with taka-diastase to aid its digestion. It is 
better to give the food in small amount every two hours than in larger 
quantity three times a day. The increase in rations, both as to variety 
and amount, should be most gradual, the physician extending the 
dieting over at least six weeks, of which the first two had best be spent 
in bed. It is well to use massage and electricity under these circum- 
stances to preserve nutrition, as in the rest cure. (See Rest Cure.) 
Beef-tea and soups had better be avoided during the early stages of 
the treatment, as they will irritate the stomach. Soft-boiled eggs, 
tender chicken or game, and minced lamb may be finally given. 
Cheese, coffee, tea, beer, and ale are to be avoided, as are all very hot 
drinks. Fresh green vegetables may be used in moderation, but fresh 
bread and unripe fruit must be carefully avoided. When milk is taken 
it should be warmed. The presence of gastric pain indicates that the 
diet must be cut down in quantity and the nutrition maintained solely 
by rectal injection. 

The drug treatment of these cases is palliative as to pain, and 
curative. For the pain counterirritation of a more or less severe and 
constant type should be applied to the epigastrium, either as a spice 
or mustard plaster or by means of a hot-water bag. The counter- 
irritation should be as continuous as possible. Sodium bicarbonate 
and the subnitrate and subcarbonate of bismuth are also of service in 
the dose of 20 grains (1.3) each, and to these may be added from 
2V to J grain (0.003-0.015) of morphine hydrochlorate or 1 grain 
(0.08) of codeine. These may be given thrice daily if necessary. 
Only the smallest dose of morphine necessary to relieve the pain should 
be employed. A valuable treatment for the pain and for the ulcer 
itself is the following pill: 

1^ — Argenti nitratis gr. iv. (0.25). 

Extracti hyoscyami gr. x velxx (0.60-1.3). — M. 

Ft. in pil. No. xx. 

S. — One pill half to one hour before meals. 

Another useful drug in such cases is chloretone in 5-grain (0.30) 
doses given in capsule. When great gastric acidity is present which 
is not controlled by the pill named above or by the use of chloretone, 
the following formula may be employed : 

1$ — Sodii bicarbonatis, 

Magnesii oxidi ponderosi, 

Calcii carbonatis . . . . . . aa ^j (30.0). 

01. menthse piperita Ulx (0.60).— M. 

S. — A saltspoonful every two hours in a little water. 

For the constipation which is frequently present the patient may 
receive a dose of Carlsbad salt or phosphate of sodium, or even the 
sulphate of magnesium, although it is best, as a rule, to rely upon the 



670 DISEASES. 

enema which is used to wash out the bowel each day and to produce 
a movement. 

For the relief of vomiting and of hsematemesis absolute abstinence 
from food, so far as its administration by the mouth is concerned, is 
to be insisted upon. Nutrition must be maintained under such circum- 
stances by feeding by the rectum with predigested food. (See Part 
III.) If the vomiting is persistent, small doses of cocaine, \ grain 
(0.015), may be given, or cocaine and bismuth subnitrate combined. 
Sometimes drop doses of creosote are useful, or phenol may be given 
in the same dose with 20 grains (1.3) of subnitrate of bismuth. One 
of the best remedies for hsematemesis is oil of turpentine in the dose 
of 5 to 10 minims (0.30-0.60) four times a day. In other cases 
good results will often follow the use of adrenalin chloride or of the 
solution of the subsulphate of iron (Monsel's solution) in the dose of 
3 minims (0.20) in a little water every half-hour or by the employ- 
ment of 3 grains (0.15) of the salt itself in pill. Cold compresses 
or an ice-bag may also be applied to the epigastrium for the same 
purpose. 

Should perforation of the stomach occur, operative interference is 
to be promptly resorted to. Shock is to be treated by supportive 
treatment in the way of heat to the limbs and the hypodermic use 
of ether, brandy, or ammonia. Morphine should also be given 
freely unless collapse is too pronounced, as it tends to diminish 
abdominal pain and inflammation. 

GASTRITIS (ACUTE). 

This is generally due to the ingestion of irritant foods or drinks, 
rarely arising in its true acute form from other causes. 

The treatment is to be directed entirely to the prevention of the 
spread of the inflammation and to the relief of that already developed. 
If the patient is seen soon after the onset of the trouble, the stomach 
is to be emptied of all irritant substances by means of vomiting induced 
by large draughts of warm water, or, better still, by the use of the 
stomach-tube, as the retching may increase the irritation. Mucilaginous 
drinks are to be given freely, and albuminous materials seem especially 
useful. Oils and similar protective liquids aid in preventing further 
damage. Opium, to allay pain and the local and systemic irritation, 
is invaluable. This drug should always be given in liquid form, and 
the deodorized tincture is the best in this respect, owing to its freedom 
from narcotine. Paregoric contains too little opium to be of value. If 
the stomach will not retain drugs, they should be given by the rectum. 
If evidences of collapse appear, hot applications, atropine, or belladonna 
should be exhibited. It is important that the heat should be applied 
over the epigastrium and chest, and a flaxseed poultice is the best 
method of doing this. Practically, the same rules hold good in regard 
to diet in both acute gastritis and in gastro-enteritis. 



GLAUCOMA. 671 

GASTRO-ENTERITIS. 

Gastroenteritis is a condition of inflammation affecting the entire 
alimentary canal in some instances, and commonly produced by the 
ingestion of some irritant substance, either in the form of bad food, 
poisons, or mechanical irritants, such as grape-seeds or cherry-stones. 
The symptoms accompanying it are exceedingly various, but consist 
chiefly in pain of a griping character, with watery or mucous stools, 
or, if the inflammation be very severe, absolute and unyielding con- 
stipation may be present. The nervous symptoms depend upon the 
degree of irritation and the general nervous tendency of the patient; 
and if the trouble is very severe, a condition of shock or collapse 
may result. 

If the irritation is very intense, exfoliation of the mucous membrane 
may take place, the epithelium coming away in shreds. 

The treatment of gastro-enteritis depends upon its severity and 
cause. Almost always we first allay the pain and tendency to inflam- 
mation by the hypodermic use of morphine, and immediately follow 
this or precede it by an emetic of a non-irritating and rapidly acting 
type, such as apomorphine, provided there is reason to believe that 
the poison or food still remains in whole or in part in the stomach. If 
the irritant has been taken some time before the physician is called 
to see the case, emetics are contraindicated, as by disturbing the 
abdominal contents they increase the inflammation. If the irritant 
has passed the pylorus, castor oil in the dose of 2 to 3 table- 
spoonfuls (30.0-45.0) to an adult may be given to sweep out the 
offending materials and lubricate the intestinal walls. In other 
cases sulphate of magnesium is to be used in preference to sulphate 
of sodium or Rochelle salt, as they are both slightly irritant. The 
sulphate of magnesium is of value, because, in addition to its purgative 
effect, it also depletes the inflamed bowel. Having got rid of all offend- 
ing materials, opium is to be freely used to allay irritation and control 
diarrhoea (see Diarrhoea), and hot compresses are to be applied to 
the belly, or a spice or mustard plaster used instead. Vomiting when 
excessive is to be treated in the manner described under that head. 
The after-treatment of acute gastro-enteritis is very important, both 
in respect to food and drugs. Predigested foods are therefore in many 
cases indispensable, and a carefully regulated diet is a sine qua non. 
The abdomen should be protected from cold by a flannel binder. 

GLAUCOMA. 

Glaucoma, a disease dependent upon an increase of intraocular 
pressure, appears in an acute or a chronic form. The affection in 
general terms is characterized by halos appearing about gasflame; 
periods of obscuration of sight; shrinking of the nasal half of the field 
of vision; narrowing of the anterior chamber of the eye; anaesthesia 



672 DISEASES. 

of the cornea; and increased tension of the eyeball. In the "glauco- 
matous attack," or acute glaucoma, the injection of the eyeball is 
intense; the lids swell, there is photophobia, the cornea is steamy, the 
pupil dilated and motionless, and the vision rapidly destroyed. The 
case may be mistaken for iritis or acute ophthalmia — a fatal blunder. 
Iridectomy or an equivalent measure is the best treatment for 
acute glaucoma. If for any reason this is delayed, a solution of the 
sulphate of eserine, 1 to 2 grains to the ounce (0.06-0.12 : 30.0), or 
pilocarpine hydrochlorate in twice this strength, should be dropped into 
the eye every two or three hours until relief follows. Atropine must not 
be employed. Hot compresses are also useful to alleviate the pain if 
for any reason operation is delayed, and full doses of salicylate of 
sodium should be administered. In chronic, non-congestive glaucoma 
the myotics are useful; if these fail, iridectomy may be employed, and 
in recent times excision of the superior cervical sympathetic ganglion 
has been recommended. 

GONORRHOEA. 

The therapeutics of urethritis varies in accordance with whether 
the disease is acute or chronic, and is very greatly modified by the 
seat of inflammation — a posterior urethritis, for anatomical and 
mechanical reasons, not being amenable to the same treatment which 
will prove successful when the disease is limited to the penile portion 
of the urethra. 

The membranous and prostatic portions of the urethra constitute 
its posterior part. They are surrounded by layers of powerful muscles 
which keep the canal constantly occluded and which play the part 
of vesical sphincters. Hence hand injections forced into the urethra 
pass to, but not beyond, its membranous part, and are worse than 
useless if administered with the intention of combating inflammation 
of the posterior urethra. It is the rare exception for gonorrhoea to 
be confined to the anterior urethra. Usually it extends back, and a 
common cause of gleet is failure to recognize this fact, and consequently 
the omission of measures calculated to cure the deep inflammation. 

Since the general acceptance of the gonococcus as a specific cause 
of gonorrhoea the treatment of acute anterior urethritis has been 
mainly antiseptic, those drugs being chosen which are found to act 
most powerfully upon the specific germ, and at the same time produce 
the least irritant action upon the mucous membrane. Bichloride of 
mercury, as representing the most powerful germicide known to 
medicine, has been used extensively. The main objection to its action 
lies in the fact that when employed in efficient strength it is exceed- 
ingly irritating. Potassium permanganate, though of less antiseptic 
power, is therefore preferred. A fairly satisfactory treatment consists 
in thoroughly and repeatedly flushing the urethra with permanganate 
lotion, 1 : 6000. This may be accomplished by means of a fountain- 
syringe and a blunt, flattened, conical nozzle of such size that when 



GONOBRHCEA. 673 

its extremity is passed into the meatus its sides will be grasped so 
tightly that gentle pressure upon the nozzle will prevent regurgitation 
of fluid. The bag is filled with hot permanganate solution, 1 : 6000, 
and is elevated six feet above the level of the bladder. After first 
thoroughly washing the glans and lips of the meatus the nozzle should 
be inserted and held firmly in place until the entire anterior urethra is 
distended, when the nozzle should be slightly withdrawn and the 
urethral contents allowed to escape. After this has been repeated 
several times the nozzle is held firmly in place till 3 or 4 ounces of 
solution have passed into the bladder. This treatment should be 
repeated night and morning for at least a week, the strength of the 
permanganate solution being gradually increased up to 1 : 2000, if 
undue irritation is not caused by such increase. If at the end of a 
week no gonococci can be found, the irrigations should be continued 
once daily for four days, supplemented by astringent injections. When 
gonococci persist, the irrigations should be continued for two or three 
weeks. When this method of irrigation cannot be practised, a syringe 
with a conical nozzle and with a capacity of at least 1 ounce may be 
employed: this should be used two to six times a day, two syringefuls 
of the dilute lotion being injected immediately after urination. The 
liquid should be forced in very gently, being allowed to flow out by 
slightly lessening the pressure of the nozzle upon the meatus when the 
anterior urethra is full. When large injections are attempted by the 
ordinary small urethral syringe, the frequent application of the latter 
to the meatus occasions much irritation. It is desirable that the 
injections should pass back into the posterior urethra, since this portion 
of the canal is usually involved in acute inflammation. 

Copious irrigations inaugurated in the earliest stages of gonorrhoea 
are frequently successful in producing a complete cure in a few days. 

The following prescriptions used as hand-injections are among the 
most efficacious in checking persistent discharge: 

R — Nargol, argyrol, or protargol . . . . gr. iij (0.20). 
Aquae destil g iij (90.0).— M. 

H— Fluidext. hydrast. (colorless) . . . f giv (16.0). 

Bismuth, sublact ^vj (24.0). 

Glycerin f.^iv (16.0). 

Aq. destil. ....... q.s. fgvj (180.0).— M. 

1$ — Zinc, sulphatis, 
Phenolis, 
Alum. crud. . . . . . ■ . aa gr. xij (0.80). 

Aq. destil. ... fgvj (180.0).— M. 

S. — Locally. Dilute if painful. 

When the gonorrhoea has already assumed a markedly inflamma- 
tory type, with swelling and oedema of the penis, redness and ever- 
sion of the meatus, and great sensitiveness of the urethra, and seems to 
be aggravated by mild irrigations, the penis should be wrapped in 
cloths kept wet with alcohol and water or lead-water and laudanum. 

43 



074 DISEASES. 

With the subsidence of acute inflammatory symptoms and the appear- 
ance of copious discharge the injection treatment may be inaugurated. 
It must be remembered that injections may in themselves prevent the 
discharge from entirely disappearing. Hence, as the symptoms 
ameliorate the injection should be made less frequently, finally being 
entirely omitted for some days if the discharge seems to continue 
longer than usual. 

Internal medication and constitutional treatment are most important 
in all forms and stages of gonorrhoea. It is almost universally accepted 
that certain drugs, such as copaiba, cubebs, and oil of sandal-wood, 
when eliminated through the kidneys, possess the power of inhibiting 
the growth of the gonococci or of destroying their vitality. Bacterio- 
logical research has shown that of this class of remedies copaiba partic- 
ularly possesses such power. To this drug may be added phenyl 
salicylate, which has been proved by laboratory and clinical tests to 
exert a powerful germicidal action upon the gonococcus. Clinical 
experience has shown that oil of sandal-wood is of great value in 
the treatment of chronic gonorrhoea. An excellent formula for the 
administration of balsams is the following: 

If— 01. santal gr. v (0.3). 

Balsam copaibse rriv (0.3). 

01. cinnamom TTlj (0.05). — M. 

Encapsulate. 
S. — These capsules should be taken one hour after meals, from six to twelve 
being administered a day. 

Obstinate chordee may require bromide of potassium and chloral. 
Of these a drachm of the former must be given at bedtime, and 10 
grains (0.60) of the latter; this may be repeated in the night if painful 
erections persist. Lupulin in 30-grain (2.0) doses is also endorsed. 
When practicable, opium or belladonna suppositories, or hypodermic 
injections of morphine gr. \ (0.015) and atropine gr. -^ (0.001), will 
prove very satisfactory. In all cases the patient should be instructed 
to take a prolonged hot bath before going to bed, and to rise once 
during the night to pass water. 

Ardor urinye is usually relieved by the use of demulcent drinks and 
by the employment of bicarbonate of sodium or citrate of potassium 
in sufficient doses to render the urine but slightly acid. Either of 
these drugs is conveniently administered in the form of compressed 
tablets, taken one or two hours after meals in 10-grain (0.60) doses, 
the quantity being increased, if necessary, until the desired effect is 
produced on the urine. The instillation into the urethra, by means 
of an eye-dropper, of a 4 per cent, solution of cocaine a few minutes 
before urination markedly diminishes the burning. Finally, this 
symptom may often be relieved by instructing the patient to pass 
water with the penis submerged in a vessel containing water as hot as 
can be borne. 

Where the inflammation is of a high grade and attended by fever 



GONORRHCEA. 675 

and general malaise, rest in bed, milk diet, and the administration of 
6 minims (0.40) of tincture of aconite, repeated every two or three 
hours, is followed by marked relief. 

In regard to the general treatment of a patient suffering from gonor- 
rhoeal urethritis rest in bed is particularly desirable. This, however, 
is rarely possible, and the surgeon must be content with enforcing the 
avoidance of all active exertion and the observance of as much rest of 
mind and body as is compatible with the continuance of the daily 
routine of business life. While skimmed milk or buttermilk diet is 
theoretically desirable, the advantages to be gained by it are scarcely 
sufficient to justify insistence upon such a regimen, especially as it 
would excite suspicion as to the presence of venereal disease; hence 
a light diet, consisting mainly of vegetables and fruits, and in quantity 
about half that usually taken, with a minimum amount of meat, should 
be advised. In addition the patient should be induced to drink lib- 
erally of plain water or any of the sparkling mineral waters, as by this 
means the urine is not only rendered bland, but also greatly increased 
in quantity, thus enabling the urethra to be fully flushed from behind 
many times a day. Flooding of the stomach with such large quantities 
of liquids as to produce dyspepsia is to be carefully avoided. It is 
scarcely necessary to state that copulation or any form of venereal 
excitement must be strictly interdicted. Finally, prolonged warm 
baths lasting from half an hour to two hours seem to exert a favorable 
influence upon local inflammation. 

The distressing symptoms of acute posterior urethritis do not usually 
develop until the disease of the penile portion of the urethra has run a 
course of two or three weeks. During the very acute symptoms local 
treatment applied to any portion of the urethral canal probably aggra- 
vates the condition, and even the internal administration of balsams 
and antiseptics must be employed with very great caution, their use 
being suspended at once if the inflammation seems to be aggravated. 
Hence, when in the third week of gonorrhoea there is a violent out- 
break of inflammation in the membranous and prostatic portions of the 
urethra, suspension of all active treatment is indicated. The bowels 
are kept open; the diet is carefully regulated; the urine is rendered 
bland, unirritating, and antiseptic; repeated warm baths are ordered; 
the painful symptoms being controlled by opium and belladonna, 
administered either hypodermically or in the form of a suppository. 
When the acute symptoms subside, the quantity of antiseptics taken 
by the mouth may be increased, balsams may be added, and local 
treatment may be directed first to the posterior urethra, after the cure 
of which the anterior urethritis should receive attention. It has been 
stated already that injections forced into the meatus rarely penetrate 
beyond the bulbous portion of the urethra; hence to influence the 
deeper portions of this canal some other method of applying drugs 
must be devised. This end is best accomplished by means of the 
gravity-bag and meatus nozzle or by the instillator. 



676 DISEASES. 

The patient is first instructed to empty the bladder of a portion of 
its contents; by this means the urethra is flushed out. The catheter 
is then introduced into the membranous portion of the canal, and by 
means of a syringe 10 minims (0.60) of the injection are forced into the 
membranous and prostatic portions of the urethra. This fluid enters 
the bladder, and is passed with the urine at the next act of micturition. 
The injection most employed is a 1 to 10 per cent, solution of nargol, 
argyrol, or protargol. Any of the injections used in anterior urethritis 
may also be now employed. These instillations should be made every 
second or third day. 

Chronic Gonorrhoea. 

Chronic gonorrhoea differs from the acute form in the fact that the 
inflammation is distinctly localized in certain portions of the urethra, 
and does not invade the whole canal with uniform intensity; hence, 
efficient treatment must be directed not to the whole urethra, but to 
the diseased areas. Foci of chronic urethritis are usually found either 
in the bulbous portion of the urethra or in the membranous or pros- 
tatic portion. If the disease is located in the anterior urethra, it will 
commonly be found to depend upon the existence of a stricture of large 
calibre. The passage of sounds of full size — cutting the meatus if this 
is necessary for their introduction — will be followed by prompt relief 
in such cases. The sounds should be used not more frequently than 
twice a week, and should be followed by copious urethral antiseptic 
flushings, best effected by the gravity-bag and short urethral nozzle, 
irrigating daily with nargol, argyrol, or protargol (1: 3000 to 1: 500), 
silver nitrate (1: 1000), mercurol (1 : 2000), or potassium permanganate 
(1:2000 to 1:500). When the general catarrhal condition is 
materially modified, by means of an ordinary urethroscope the focus 
of inflammation may be exposed, and may be treated directly by 
strong astringent solutions carried in by means of a brush or by 
absorbent cotton secured to the extremity of a long applicator. 
Nitrate of silver or sulphate of copper, 20 grains to the ounce 
(1.3-30.0), may be employed. Unna has devised a most successful 
treatment for obstinate cases of gonorrhoea. He advises coating the 
sounds with the following mixture: 

I$— 01. cocse giij (90.0). 

Cerse flav . ;. . 5ss (2.0). 

Argent, nitratis gr. xv (1.0). 

Balsam. Peruvianum 5ss (2.0). — M. 

This is liquefied in a water-bath; the sounds are dipped in it and are 
then hung up to dry. On being passed the heat of the body melts 
the coating. The objection to their use lies in the fact that the appli- 
cation is made to the entire urethra. Practically, however, their 
employment is often followed by brilliant results. 

Chronic posterior urethritis must be treated by remedies applied 
directly to the diseased area. The silver salts are more commonly 



GONORRHCEA. ^77 

successful than any other medication. By means of Ultzmann's 
instillator 5 to 10 minims (0.3-0.60) of a solution varying in strength 
from 0.1 per cent, to 5 per cent, may be employed. Irrigations are 
also serviceable; but previous to their employment the prostatic 
follicles should be emptied of their purulent contents by massage 
through the rectum. 

Finger recommends the following ointment: 

1$ — Argent, nit rat is vel cupri sulph. . . . gr. xv (1.0). 

Lanolin 5iij (90.0). 

01. olivae ojss (6.0).— M. 

By means of an ordinary catheter — which is first filled, then intro- 
duced until its eye reaches the prostatic portion of the urethra — a 
definite quantity of the ointment can be forced into the canal by a 
graduated rod. 

In many cases pressure will exert a curative action, causing prompt 
absorption of inflammatory effusion. To accomplish this result 
large sounds may be passed into the bladder. Frequently the thera- 
peutic influences of cold, together with pressure, are found beneficial. 
The best means of combining these two remedies is found in the 
psychrophore, an instrument in the shape of a sound, but so arranged 
that a stream of water flows through its interior. 

It must be borne in mind that chronic gonorrhoea is commonly due 
to unskilful or not sufficiently prolonged treatment of the acute stages. 
Not only should the treatment of acute gonorrhoea be continued until 
the gonococci have entirely vanished, but for fully two weeks after 
the disappearance of all symptoms of inflammation. The same rule 
holds good in regard to the chronic manifestations of the disease. 
Only after careful examination of the urine fails to show any sign of 
inflammatory trouble for at least two weeks should the treatment be 
suspended; and this should not take place suddenly, but the intervals 
between the applications be gradually increased in length, the patient 
being carefully watched in the mean time. 

Per contra, it must not be forgotten that long-continued irritant 
treatment may in itself indefinitely prolong a urethral discharge. 
Hence it is wise to suspend all injections in certain cases, and to exam- 
ine the discharge carefully, as found in the urine, to determine whether 
or not the continuance of symptoms is dependent upon this cause. 

There is a mucous secretion which quite frequently follows gonor- 
rhoea, but which is in no way dependent upon the persistence of this 
disease. Microscopic examination will at once determine its nature. 
It is probably most rapidly cured by attention to general hygiene and 
by tonic and supporting treatment. 

Complications of Gonorrhoea. 

Among the many local and general complications which may occur 
in the course of an acute or subacute gonorrhoea are balanitis, balano- 
posthitis, prostatitis, and epididymitis. 



678 DISEASES. 

Balanitis and balanoposthitis are treated by perfect cleanliness, 
The discharge must be thoroughly washed out, and the surface must 
be dried and isolated. The thorough cleansing of the parts is best 
accomplished by weak astringent solutions, such as the chloride of 
zinc, 4 grains to the ounce (0.25-30.0), 1 per cent, boric acid, or 
1.5 per cent, phenol; nitrate of silver is particularly valuable, and 
in the proportion of 1 grain to the ounce (0.06-30.0) will be found 
sufficiently strong for use as a wash or injection. The superficial 
ulcerations may be further touched with the solid stick of the nitrate 
of silver. The prepuce having been retracted and the parts having 
been thoroughly washed, dusting-powder, such as tannin or oxide of 
zinc, is distributed over the surface of the inflamed parts; the glans 
is then covered with a thin layer of absorbent cotton and the prepuce 
drawn forward. This dressing is to be repeated three times daily. 

If the phimosis is so tight that the prepuce cannot be retracted, 
cleansing, astringent injections, and wrapping the penis in one or 
two thicknesses of gauze or other thin fabric, constantly kept wet 
with dilute lead-water, will be the treatment indicated. If, in spite 
of this treatment, inflammatory symptoms become more marked, 
splitting the foreskin or circumcision is indicated. 

Prostatitis is a rare complication, and in its early course presents 
the symptoms of posterior urethritis. Where the acute symptoms are 
fairly developed direct local treatment is of little avail. Rest in bed, 
light diet, careful regulation of the bowels, medication to render the 
urine bland and unirritating, elevation of the pelvis, local depletion 
by means of leeches applied to the perineum, rectal ice-bags, and the 
administration of morphine and belladonna, either by means of sup- 
pository or by hypodermic injection, represent the general treatment 
of all inflammatory conditions at or about the neck of the bladder. 
In the great majority of cases prostatitis undergoes prompt resolution, 
and this is more powerfully influenced by rectal injections than by any 
other method of treatment. For this purpose a two-way rectal tube 
must be employed, the nozzle of which is directed against the pro- 
jection of the prostate into the bowel. From 2 to 4 quarts (2 to 4 
litres) of normal saline solution, either very cold or as hot as can be 
borne, are allowed to flow into the rectum by gravity, this arrange- 
ment of the tubes allowing the injection to flow out as rapidly as it 
flows in. This treatment should be repeated three or four times a 
day. When, in spite of careful treatment and the free use of anodynes 
and antispasmodics, there is retention of urine, a soft catheter should 
be passed into the bladder and allowed to remain there. 

If general and local symptoms denote abscess-formation, the pus 
should be evacuated by perineal incision as soon as its' presence is 
positively determined. It is true that the pus collection usually is 
spontaneously discharged into the urethra, but this result cannot cer- 
tainly be depended upon, and, at best, is an unsatisfactory termina- 
tion of the trouble. 



GONORRHCEA. 679 

When the inflammation runs into a chronic type, the treatment 
suitable for chronic posterior urethritis is indicated — namely, the use 
of large cold steel sounds, massage, and local applications to the pros- 
tatic urethra. In addition rectal injections, by means of the two- 
way tube, are very efficient in producing a cure. 

Epididymitis requires rest in bed, cessation of all irritating local 
treatment directed against the gonorrhoea, elevation of the pelvis 
and testicles, and the systemic treatment applicable to acute inflamma- 
tion. The general tendency of this complication of gonorrhoea is 
toward spontaneous resolution. The testicles may be supported by a 
handkerchief bandage, the base of which is passed beneath the scro- 
tum, while the ends and apex are secured in front to a circular band 
passing about the waist. To combat the agonizing pain and hasten 
cure punctures have been advised. These, by relieving tension, 
promptly alleviate the suffering. Ice-bags may also be applied, 
though it is claimed that as a result of this treatment there remains 
an obstinate induration of the epididymis. Local applications of 
nitrate of silver, guaiacol (5 per cent, ointment), and of tincture of 
iodine are also said to act beneficially. 

Since it is usually impossible for a patient suffering from gonorrhoeal 
epididymitis to keep to his bed, a treatment must be devised which 
will allow him to attend to his business, and at the same time will 
prevent the inflammation from becoming aggravated. The part 
must be splinted; if at the same time uniform pressure can be applied, 
the cause of the trouble will be still further favorably modified. These 
indications are complied with, partially at least, by strapping the 
injured testicle. For this purpose a number of adhesive resin strips, 
each half an inch wide and long enough to pass three-fourths around 
the swelled testicle, are cut. The first strip encircles the scrotum 
between the affected testicle and the body, tightly imprisoning the 
former in a pouch of skin. The succeeding strips are then placed, 
each overlapping the other in such a manner that the entire pouch is 
covered in, and a handkerchief bandage, applied as described above, 
may then be used to elevate the testicle. A better means of securing 
rest and pressure, and at the same time exerting the resolvent influ- 
ences of heat and moisture, is offered in the dressing proposed by 
Horand-Langlebert. The entire scrotum is first enveloped in a thick 
layer of cotton; over this is placed a piece of rubber-dam sufficiently 
large to cover in the cotton, and the dressing is completed by a 
jock strap, gored at the sides and provided with tapes to allow 
of close fitting. Unless there be decided swelling of the spermatic 
cord, this dressing usually allows the patient to attend to his business, 
and is followed by as prompt resolution as though confinement to bed 
had been insisted upon. 

When the acute symptoms have disappeared attention must be 
directed to the removal of infiltration, which if it persists may be a 
cause of sterility. This is accomplished by the continuance of heat, 



680 DISEASES. 

moisture, and pressure; by local applications, such as iodine gr. iv 
(0.25) in lanolin §j (30.0), or of equal parts of mercury ointment and 
belladonna ointment, or by ichthyol, with lard half and half, and by 
the internal administration of iodide of potassium, 3 to 5 grains 
(0.20-0.30) three times daily. 

Gonorrhoea in the Female. 

The symptoms of acute gonorrhoea in the female are usually so 
mild that the attention of the physician is rarely called to the disease 
until it has reached its chronic form and has invaded the uterus and 
its appendages. When, however, acute urethritis is found, the treat- 
ment, both local and general, is conducted on the same principles as 
when the disease attacks the male urethra. During the most acute 
stage no local treatment is advisable, but subsequently injections can 
be made with the ordinary hard-rubber syringe, not more than a 
drachm and a half of the liquid being employed at a time. If the 
urethral discharge persists, the seats of the suppuration are readily 
found by the endoscope tubes, and treated directly by applications of 
strong solutions of nitrate of silver or sulphate of copper. The results 
of treatment are commonly satisfactory. 

Acute vaginitis is not very frequently observed, excepting in chil- 
dren and young girls. In addition to the general treatment of inflam- 
mation, local treatment directed to cleansing thoroughly the inflamed 
surfaces of discharge and acting upon them by a strong antiseptic 
lotion will be followed by a rapid cure. The patient is instructed to 
irrigate the vagina three times daily with 2 pints (960 c.c.) of bichlo- 
ride-of -mercury solution, 1 : 4000, thrown in by means of a fountain 
syringe. For this fluid to reach every portion of the diseased mucous 
membrane it is necessary that the patient should lie upon her back 
with the hips elevated. Before rising a pledget of absorbent cotton 
is placed between the labia. During the most acute stage of vaginitis 
hot-water injections and prolonged hot sitz-baths are indicated, In 
addition to the antiseptic irrigations which the patient is directed to 
make, the physician should every second day insert a speculum and 
paint every portion of the diseased mucous membrane with nitrate- 
of-silver solution varying in strength from 4 to 40 grains to the 
ounce (0.25-2.60: 30.0). The vagina should then be packed with 
tampons of absorbent cotton, which may be dusted with astringent 
medicaments. 

Vulvitis corresponds to balanitis in the male, and is treated in a 
similar manner. Cleanliness is the most essential point in securing 
a cure. The parts are thoroughly washed with weak antiseptic 
lotions, and the abraded mucous surfaces are kept from coming in 
contact by means of a layer of absorbent cotton or a piece of lint 
soaked in dilute lead-water or other mild astringent solution. 



GOUT. 681 



GOUT. 



Gout is a word used to signify a series of manifestations occurring 
chiefly in those who have led an inactive life devoid of exercise, have 
lived on the fat of the land, and partaken more frequently of alcoholic 
beverages than of water; or it occurs in persons who do not live in 
this way, but whose ancestors have done so, and have transmitted 
to them the gouty taint or diathesis; or, once more, in those who 
have had poor food for a long time. In other words, it is a disorder 
of nutrition and metabolism. Very few Americans have gout in its 
marked and characteristic forms, owing to the active life they pur- 
sue, and to the fact that the inhabitants of the Western hemisphere 
drink large amounts of water, thereby continually dissolving effete 
matters in the system and washing them away. Nevertheless many 
Americans suffer from w T hat may be called lithaemic symptoms, which 
are due to lack of exercise, overeating, and perverted metabolism. 

The therapeutic importance of pure water in this state is remark- 
able, but the so-called lithia waters depend for their value more upon 
their freedom from lithium salts than upon their presence. When a 
patient goes to medicinal springs, by continually drinking water he 
washes out the kidneys and prevents deposits of effete matters 
throughout the body. In a gouty individual the liquids of the body 
may be said to be so overladen with salts that they deposit them 
wherever a spot is found which is easy of access, just as water laden 
with lime forms a deposit on the sides of its bed in times of drought 
and dissolves and removes these formations w T hen a freshet takes 
place. Very often, when such waters are not attainable, satisfactory 
results will be obtained from ordinary distilled water, the insipid taste 
of which can be overcome by charging it with carbonic acid gas. 

When an acute attack of gout comes on, it is generally situated, as 
is well known, in the joint of the big toe, but it may involve any 
part of the body, even to the heart and the abdominal viscera. By 
far the best remedy for the relief of the pain, if it is unbearable, 
is morphine, which should be given hypodermically. At the same 
time the best remedy for gout that we have, colchicum, should be 
freely given until the patient shows the full effect of the drug, as 
evidenced by gastrointestinal discomfort or pain and slight laxity of 
the bowels. The drug should be used in the form of the wine of 
the seed, in the dose of 40 minims (2.6) at first, and increased by 2 
minims (0.10) every four hours until relief is obtained or symptoms of 
overdose appear as noted above. In other instances the method of ad- 
ministration suggested in the article on Colchicum may be resorted to. 

Many physicians at the present time prefer the somewhat more 
agreeable method of using colchicum in the form of colchicine sali- 
cylate, which is a mixture of colchicine and oil of gaultheria, about 
Y^ grain (0.0006) of colchicine being present in each capsule and 3 
to 6 being given each day, at intervals of a few hours. 



682 DISEASES. 

The local treatment of gout, when it is active, consists in the appli- 
cation of a number of remedies. For hospital practice a very useful 
mixture is made by adding 1 part of bicarbonate of sodium to 9 parts 
of linseed oil. The joint is then wrapped in a piece of lint soaked 
with this concoction. In other cases collodion may be applied in one 
or two good coats, not more, with relief, and in still others oil of pep- 
permint has been recommended. It is to be remembered, however, 
that the inflamed joints are not to be treated by depletion through 
leeches or bleeding, as by this means they ultimately become worse; 
or, in other words, the treatment of gouty inflamed joints is not iden- 
tical with that of inflamed joints from other causes. When the pains 
of acute gout are very severe at night, potassium iodide, in the dose of 
15 grains (1.0) at four or five o'clock in the afternoon, will sometimes 
give relief; this drug should always be combined with colchicum if 
the disease is subacute or chronic. 

In chronic gout, except during the acute exacerbations of the dis- 
ease, colchicum is almost useless, but potassium iodide should be 
pushed to the point of iodism if the trouble be painful. Here diet 
forms an important part of the treatment, and should consist of foods 
which are not fatty nor rich, but plain and nourishing. Milk and 
eggs, the white meat of chicken and fruits, cooked without sugar 
being added, are allowed, tea and coffee being used only in modera- 
tion. If any wine is taken, it must be followed by copious draughts 
of pure water, and this last article should be used ad libitum. On 
the other hand, pastries, and, more than all, sweet wines, are the 
worst things that such a patient can take, and must be absolutely 
prohibited. 

The insomnia of chronic or subacute gout is best overcome by 
potassium bromide and chloral, the former drug being the safest and 
best. 

Nothing should be done in the neighborhood of gouty joints which 
will injure the skin, as it is easily disorganized and its injury may lead 
to erysipelas. Where the deposit around a joint is very great and 
the normal movements are impossible, relief is often obtained by the 
application of a solution of citrate or carbonate of lithium, 5 to 10 
grains to the ounce (0.30-0.60: 30.0) of water, on lint wound around 
the parts. Where the skin is broken and will not heal, this treatment 
often permits healing by dissolving the crystals in the wound which 
prevent approximation of the edges and so cause local irritation. 

Iodine ointment or the tincture of iodine is often placed around 
chronic gouty joints with advantageous results. 

A standard remedy in subacute or chronic gout is arsenic, and its 
administration in the form of 3 minims (0.20) of Fowler's solution, 
with either perfectly pure or lithiated water, is always to be resorted 
to when the iodides and colchicum are temporarily abandoned. If 
anaemia is present, arsenic is particularly indicated, and cod-liver oil 
and syrup of the iodide of iron are also of value in this state. Gouty 



HEADACHE. (583 

patients should take as much exercise and be in the fresh air and sun- 
shine as much as possible. 

We find, therefore, in conclusion, that the use of large amounts of 
pure water free from salts, and the administration of colchicum, 
potassium iodide, and arsenic are the greater points about which 
treatment should centre. In those cases where retrocedent gout 
occurs the heart must be supported by stimulants, particularly by 
hypodermic injections of ether, until the slower drugs can act, by heat 
over the belly, by the use of opium to allay irritation, except when the 
brain and kidneys are seriously affected, by the use of diuretics and 
alkaline drinks, and finally by counterirritation in the shape of a 
mustard plaster placed over the abdomen or chest as the case may 
require. 

HEADACHE. 

(For Neuralgic Headaches, see Neuralgia; for Bilious Headache, 

see Biliousness.) 

Probably no single source of pain compares in its frequency to 
headache, chiefly because it is essentially a symptom of many dis- 
ease processes or functional disturbances. It may arise from con- 
stipation or eye-strain, from brain disease, from anaemia, from uraemia, 
from plethora, from nervous breakdown, and from a multitude of 
causes which, if they were all recounted, would cover many pages of 
this book. 1 In many instances the employment of a mild laxative, 
which will cause the bowel to empty itself thoroughly, is a necessity. 
In others a careful measurement of the amount of urine passed in the 
twenty-four hours will show that the urinary secretion is deficient in 
liquids and solids, so that effete and poisonous materials are retained 
in the blood, which produce headache. For such cases, if the urine is 
acid, the frequent use of Vichy water (Celestins Spring), to which is 
added a little bicarbonate of potassium as a diuretic, will prove of great 
service. If the urine is alkaline, 10 grains (0.60) of ammonium benzoate 
are often useful. 

Congestive headaches, dependent upon engorgement of the cere- 
bral vessels with blood, are to be treated in a number of ways. 
If any direct cause of congestion can be discovered, this must, of 
course, be removed. So far as the direct application of drugs is con- 
cerned, we find two methods of promoting a cure, according to the 
cause. Thus if the patient be neurasthenic and feeble the use of ergot 
and strychnine, which will cause contraction of the dilated vessels, is 
useful; whereas if the congestion is due to high arterial tension and 
excessive cardiac action, the bromides and the employment of vascular 
sedatives, which will produce arterial depression and so remove con- 
gestion, are indicated. It is to be remembered that when the con- 

1 See chapter on Headache in the author's Practical Diagnosis, Lea Brothers & Co. 



684 BTSEASES. 

gestion is due to vascular relaxation and weakness vascular sedatives 
are contraindicated. 

The use of a hot mustard foot-bath is of great value, and a mus- 
tard plaster or dry cup applied to the nape of the neck is often of 
service in congestive headaches, while in severe cases an ice-bag applied 
to the head or leeching behind the ears or on the temples may be 
resorted to. Bleeding often gives relief at once in severe congestive 
headache. 

In nervous women who suffer from headache much comfort and 
relief will often ensue if the top of the head be wet with one of the 
following formulae : 

1^ — Spt. camphorae fgj (30.0). 

Spt. lavandulse, 

Alcoholis . . . . . . . . aa f gij (60.0).— M. 

S. — Apply locally. 

Or, 

1$ — Camphorae, • 

01. menth. piperit. aa 3] (4.0). 

Chloroformi f§ss (16.0). 

Alcoholis q. s. ad f §iij (90.0). — M. 

S. — Shake the bottle and apply a little of the liquid to the head. 

In other instances bathing the head with cologne water to which 
have been added 5 grains (0.3) of menthol to the ounce is useful. 

Where headache depends upon fatigue, either general or local, 
stimulating treatment is necessary. If eye-strain be the cause, full 
doses of strychnine or nux vomica are of service, but these remedies 
cannot be used if there is much retinal irritability. Proper eyeglasses 
are, of course, indicated in such a case. In many instances a combi- 
nation of caffeine, bromide of potassium, and antipyrin is very 
successful, as follows: 

I$— Caffeinae citratis gr. xl (2.60). 

Potassii bromidi giv (16.0). 

Antipyrini £ij (8.0), — M. 

Ft. in chart. No. xx. 

S. — One powder in water as needed. 

Sometimes the caffeine makes the headache more acute, and if this 
occurs only the antipyrin and bromide can be used. (See articles on 
Antipyrin, Acetanilid, and Phenacetin.) 

Another useful prescription is: 

1$ — Extract, guaranae gr. x vel xx (0.60-1.3). 

Ext. apii graveol gr. x (0.60). — M. 

Ft. in capsul. vel chart, vel pil. No. x. 

S.— One every half -hour till relieved or three are taken. 

Sleep is generally a more useful prescription than any drug, and 
if city life creates so much mental anxiety during the day as to be 
wearing upon the nervous system or make the patient wakeful at 
night, business must be put aside and health and recreation sought 



HEART DISEASE. 685 

at a watering-place. Horseback exercise is very useful indeed, and 
should be resorted to by all who can afford it if they are sufferers 
from nervous headaches. Walking is also useful. 

A form of headache which is often very severe, sometimes fleeting, 
sometimes persistent, is that due to gout, and it is to be treated by 
means quite distinct from those named so far. Some practitioners of 
wide experience employ salicylic acid in doses of from 5 to 15 grains 
(0.3-1.0), while others rely on the iodide or acetate of potassium. 
(See Migraine.) 

Other cases of a gouty headache require colchicum, particularly 
if the gout be widely distributed in its manifestations, and to these 
Hamilton gives: 

R — Vini colchici seminis f 5ss (16.0). 

Potassii acetatis, 

Potassii iodidi, 

Tr. cimicifugae racemosae ... aa f5v(20.0). 

Aquse destil q. s. ad f giv (120.0). — M. 

S. — Teaspoonful (4.0) every four hours. 

In cases in which anaemia is associated with the gouty tendency 
Peabody uses the following prescription, the ingredients of which are 
compatible, whereas most of the preparations of iron and salicylic acid 
are incompatible: 

Py — Acid, salicylic gr. xx (1.3). 

Ferri pyrophosphat gr. v. (0.3). 

Sodii phosphatis gr. j (0.06). 

Aquae dest. f^ss (16.0).— M. 

S. — To be taken every three hours. 

Cohen has used the following, which is more pleasant to the taste: 



Py — Sodii salicylatis 
Glycerini 
01. gaultherise . 
Tr. ferri chloridi 
Acid, citrici . 



. 5iv (16.0). 

. fgij (60.0). 

. nvxx(1.3). 

. f5iv (16.0). 

. gr. x (0.60). 



Liq. ammonii citratis, B. P. 1 . q. s. ad f§iv (120.0). — M. 
S — Dessertspoonful (8.0) in water twice, thrice, or four times a day. 

(For the treatment of migraine, see Migraine.) 

HEART DISEASE. 

(For Treatment of Angina Pectoris, see p. 571.) 

The writer classifies all forms of heart disease under this heading 
advisedly. In valvular disease the profession understands more and 
more that the mere destruction or laming of this valve or that has 

1 Liquor ammonii citratis, B. P., is made by adding 5 fluidounces (imperial meas.) of strong 
solution of citrate of ammonium to 15 fluidounces (imperial meas.) of distilled water. The 
stronger solution of citrate of ammonium is made by taking 12 ounces (avoirdupois) of citric 
acid, strong solution of ammonia 1 1 fluidounces, and adding enough distilled water to make 
24 fluidounces (imperial meas.). 



686 DISEASES. 

little to do with the treatment, although the ultimate result of the 
case is somewhat dependent upon these conditions. It matters not 
whether the leak in a valve be minute or great, provided the heart 
can still do its work; the condition of the cardiac muscle is the impor- 
tant factor to be considered. If an irreparable leak exists in a pump 
which cannot be stopped for repairs, the question is not, Can we cure 
that leak? but rather whether we can work the pump with enough 
force and rapidity to obtain all the water needed for the maintenance 
of life. Some physicians use heart tonics, such as digitalis, whenever 
they find a valve diseased, as if to mend the broken valve. Nothing 
can be more erroneous, for a valve once injured is never regenerated. 
It is only in those cases which have relaxation of the muscular fibres 
around the mitral orifice that digitalis can cure a murmur of regurgi- 
tation. 

It should be an invariable rule with every physician in examining 
a patient with heart disease to determine whether or not the tissues 
of the body receive their normal blood-supply. If they do not, even 
though the leak is so small as almost to escape notice, treatment is to 
be instituted; but, on the other hand, if the murmur heard on auscul- 
tation is as loud as that of a machine-shop and the tissues are not 
starved, no remedy is needed. Indeed, it not rarely occurs that no 
murmur can be heard in the presence of signs of circulatory feebleness, 
because the heart may be too feeble to drive the blood past the leaking 
valve with sufficient force to produce any sound. 

Another very important point in regard to the treatment of cardiac 
disease in children is the remembrance that the stunting of the body 
and the slowness of growth are not merely the result of heart trouble, 
whereby the tissues do not increase in size from lack of nourishment, 
but occur for a special purpose. Let us suppose that a child of eight 
or nine years has scarlet fever or rheumatism, which leaves the cardiac 
valves impaired in function, the question must arise: "Can the heart 
properly fill the bloodvessels?" If the heart can supply the vessels, the 
child lives, but is stunted, because Nature is wise enough to understand 
that the struggling heart has all it can do to supply even a stunted 
frame, and realizes that a rapidly increasing area of bloodvessel surface 
in a growing child would exhaust the cardiac muscle. 

The physician should not permit the parents to worry over this lack 
of growth, but by the use of gentle gymnastics or tonics, and attention 
to the general health, he is often enabled to improve the cardiac 
condition. As soon as this organ is strong enough to permit of growth, 
growth will take place. 

In the general treatment of heart disease in persons who have until 
recently had no signs of heart-failure the most important thing for the 
physician to prescribe is rest. A tired heart cannot supply an active body. 

Having made these preliminary remarks, let us turn to the direct 
application of drugs to heart disease, the chief drug in the list being, 
of course, digitalis. 



HEART DISEASE. 687 

The value of digitalis may be said to rest upon a number of influ- 
ences possessed by it. In the first place, evidence is constantly accu- 
mulating to show that digitalis increases the nutrition of the heart 
muscle by the stimulating influence which it exerts on the pneumo- 
gastric nerve, this nerve having been partly proved to be a trophic 
nerve of the heart. Aside from any such nervous influence, the heart 
muscle receives a greater blood-supply under the use of digitalis, 
since both diastole and systole are influenced by the drug, the systole 
being more complete and the diastole being prolonged and more 
extensive. 

Two theories concerning the nutrition of the heart muscle through 
its blood-supply have been promulgated. One is, that the coronary 
arteries are filled with arterial blood as the heart drives its contents 
out of the left ventricle into the aorta, or, in other words, during systole. 
The other hypothesis rests upon the belief that the contracting muscle 
prevents a free circulation of blood through the cardiac bloodvessels, 
and that the blood is driven into the coronary arteries during diastole 
by the pressure in the aorta, the aortic valves being closed. The latter 
view is incorrect so far as the coronary arteries are concerned, for 
they are filled during ventricular systole, and this systolic contraction 
of the muscular fibres urges onward the blood already in the intramural 
vessels. Nevertheless the complete passage of the blood through the 
smaller vessels of the cardiac muscle only takes place as relaxation or 
diastole occurs. The ground for this belief consists in the observation 
that a muscle when firmly contracted always presses upon its supplying 
bloodvessels, and particularly interferes with capillary flow. The 
heart of one of the lower animals, if carefully watched after the chest- 
wall is removed, will always be found to become paler during systole 
and redder during diastole. As the blood everywhere in the body 
nourishes the tissues, not when in the arteries, but while passing 
through the capillaries, it would seem self-evident that, while the 
coronary arteries are filled by the systole or contraction of the heart, 
the nutritive changes and perfect capillary circulation go on during 
diastole. If these premises are true, the increase in cardiac nutrition 
and growth under the action of digitalis is only what one would expect, 
for we have learned when studying this drug that it prolongs diastole 
and increases the force and volume of the systolic wave of blood. In 
other words, digitalis fills the coronary arteries almost to bursting, 
and so, when diastole occurs, not only floods the cardiac capillaries 
with blood, but prolongs the period during which the interchange 
between the blood-stream and tissues takes place. 1 

There is still another way in which digitalis does good in cardiac 
disease by reason of its peculiar powers. Normally, the heart beats 
fast or slow according to the demands for blood made upon it by the 
system, and its action is varied by the calls which it receives from the 

1 See article on Digitalis in Part II. of this book. 



Q88 DISEASES. 

tissues. In heart disease, with failure of compensation owing to 
leaky valves, the tissues are starved, and continually send messages 
for more nourishment to the cardiac muscle, which finally becomes 
exhausted by its endeavors to supply their wants, and beats now fast 
and now slow, uncertain what to do. If digitalis is given, the vagi 
render the cardiac action regular and effective, acting as a regulator 
and director of its energies, thereby supplying the tissues and using 
the remaining power of the heart to the greatest advantage, in addition 
to improving its blood-supply by the methods already describedc 
The starving tissues of the body having been satisfied, as Wood has 
eloquently expressed it, "the angry messengers from the periphery 
cease their callings, and the heart is at peace and in comfort. " 

From what has been said it becomes evident that this drug (digitalis) 
generally does good when the heart is weak, and we find for this reason 
that cardiac dilatation, simple cardiac failure, or heart-failure depend- 
ent upon the presence of poisons, all indicate its use. 

The mechanism of the action of digitalis in the different cardiac 
valvular lesions still remains to be described, and before doing so the 
author desires to remind the reader that a patient under the full influ- 
ence of digitalis ought to maintain the recumbent posture. (See 
article on Digitalis.) Further, the drug tends to accumulate, and 
therefore it should be stopped for several days at the end of each week 
of its use. 

Digitalis should be begun in small doses, which can be gradually 
increased in size if need be, except in cases in which great cardiac 
feebleness demands immediate and powerful stimulation, when large 
doses may be given and smaller doses used later to maintain the effect. 

Taking up the most common condition, that of mitral regurgitation, 
we find that in this disease the blood passes, in its normal flow, from 
the auricle into the ventricle, and, .when the ventricle is filled, that 
the cardiac muscle contracts on all sides equally. Normally, the 
mitral valves close the auriculoventricular opening and prevent any 
of the blood from regurgitating into the auricle, and the greater 
the pressure the tighter they become. Abnormally, the blood is still 
pressed upon on all sides as before, and, trying to escape, as do all 
liquids, from pressure, finds that, owing to disease of these valves, it 
can, in part at least, slip back into the auricle from which it came, 
rather than pass out into the high pressure of the arterial system. 
The ventricle, therefore, propels blood in two directions — in the wrong 
way and in the right way. If the leak is large enough to permit of the 
regurgitation of a large part of the blood, then death occurs. Digitalis 
does good in mitral regurgitation because, by increasing the force of 
the ventricle, it increases the friction at both the mitral leak and the 
aortic opening; but, as the aortic opening is a large one and the mitral 
leak a small one, the greater quantity of blood passes out into the cir- 
culation. It also does good because it strengthens the heart muscle 
and contracts the muscular ring which surrounds the auriculoven- 



HEART DISEASE. 689 

tricular orifice, therefore rendering it easier for the valves to close the 
mitral opening. The same fact arises for consideration as before — 
namely, that it is not the amount of leak, but the amount of supply to 
take its place, which is the vital question in the case. Rarely relief 
does not occur, and the patient is made worse by digitalis, because the 
leak is increased as much as the normal flow. 

In mitral obstruction the difficulty is that the blood cannot enter 
the ventricle with sufficient rapidity, and this part of the heart con- 
tracts bejore it is well filled. By the prolongation of diastole, the 
blood is given sufficient time to enter and the ventricle is filled, send- 
ing out into the system a large wave of blood when it contracts. Fur- 
ther than this, the stimulation of the right ventricle by the digitalis 
enables this part of the heart to overcome the tendency to congestion 
which arises from the obstruction on the left side of the heart. Often 
the right side of the heart must be relieved by venesection and active 
purgation. 

In aortic stenosis there is obstruction to the normal flow of blood 
out of the heart, and the digitalis is needed to increase the ventricular 
force, so that it may overcome the difficulty. 

In aortic regurgitation digitalis, by its stimulation of the heart, 
may cause a sufficient output of blood to clear itself of the regurgitant 
flow, but in many cases the drug fails because the prolongation of 
diastole gives so much more time for the blood to flow backward into 
the dilating ventricle. The cardiac remedies to be used in such cases 
are strophanthus, in the form of the tincture, dose 5 to 10 drops (0.30- 
0.60); adonidin, dose \ to \ grain (0.015-0.03), and sparteine, h grain 
(0.03). These remedies may also be used in the other forms of cardiac 
disease where digitalis fails. It is important to remember, however, 
that some cases of aortic regurgitation do improve, at least temporarily, 
under digitalis. 

Murmurs associated with evidences of cardiac failure do not always 
indicate the presence of valvular disease, for dilatation of the mitral 
orifice may prevent the proper approximation of the valves. In such 
a case digitalis, by relieving the relaxation, may produce cure of an 
apparent valvular defect. 

Physicians often meet with cases of severe cardiac disease in which 
there are present a laboring heart, distended jugulars, and cyanosis, 
indicating engorgement of the right ventricle. This is to be relieved 
by free venesection from the arm, and, after the engorgement is removed, 
by the use of digitalis. 

In many cases of cardiac disease there are associated with the heart 
lesion general debility and anaemia. These cases should be treated 
not only by the use of heart tonics, but also by iron, arsenic, simple 
bitters, and, if constipation is present, by mild purgatives. 

In cardiac dropsy digitalis and the other heart stimulants do good 
by raising blood-pressure and pulse force, and in some instances by 
stimulating the kidneys to increased efforts at elimination. (See 

44 



690 DISEASES. 

Dropsy.) In these cases, too, the patient will often be greatly bene- 
fited if he receive every few days a full dose of blue mass or of one of 
the hydragogue cathartics, which will relieve the dropsy and unload 
the portal circulation. A useful formula under these circumstances 
is as follows: 

R — Ext. sambuci folii gr. ij (0.12). 

Ext. oxj'dendron arborei . . . . gr. ij (0.12). 

Ext. scillae gr. £ (0.016).— M. 

Ft. in pil. No. 1. 

S. — Take one pill three or four times a day. 

On the other hand, if the heart is feeble and the arterial tension is 
high, not only must nitroglycerin be given to relax the spasm, but in 
addition a cardiac tonic must be employed which at the same time that 
it stimulates the heart will not raise arterial pressure, as, for example, 
strophanthus, in preference to digitalis, which stimulates the arterial 
system and increases the tension. As digitalis is prolonged in its 
effect and nitroglycerin is fleeting, the digitalis should be given every 
eight or twelve hours, and the nitroglycerin every three or four hours. 

In sudden cardiac failure from weakness or poisons the use of ether 
and ammonia is to be resorted to at once, and these are to be followed 
by alcohol and digitalis if necessary. Ammonia is a direct heart 
stimulant, as are also alcohol and ether. 

In cardiac palpitation dependent upon indigestion, this condition 
must be relieved by appropriate digestive remedies; but in that form 
of palpitation due to overexertion or heart strain digitalis is useful. 
Iron is to be used if the irritability is due to anaemia. Tea, coffee, 
tobacco, and excessive venery are to be forbidden. Sometimes nux 
vomica does good by stimulating the heart and nervous system, and 
belladonna seems of great value where arhythmia is present. In other 
cases of arhythmia the patient will be more benefited by the use of 
cactus grandiflorus and sparteine, and sometimes a prescription of 
aconite and digitalis, as suggested in the article on Aconite. 

In cardiac dilatation and asthenia digitalis is often very useful; but 
should the patient be advanced in years and have a tendency to 
arteriosclerosis we should, simultaneously with its use, give nitroglyc- 
erin to relieve any arterial spasm which resists the action of the heart. 
Very often such patients will suffer from scanty secretion of urine 
and albuminuria, and will develop congestion of the kidneys. This 
may be controlled and greatly relieved by the use of full doses of 
digitalis, say 5 drops of the tincture every four hours, with 20 grains 
of bitartrate or citrate of potassium every four hours. The addition 
of the alkaline diuretic very greatly aids in the diuretic effect of the 
digitalis in these cases. Sometimes diuresis can only be established 
after free purgation. In some cases it is best to substitute for the 
digitalis either strophanthus or caffeine. Both should be given freely, 
say 3 grains (0.20) of caffeine or 10 minims (0.60) of the tincture of 
strophanthus every four hours. (See Nephritis.) 



HEAR T DISEASE. 691 

Cardiac hypertrophy is rarely seen without some other lesion accom- 
panying it, but it may occur from prolonged and excessive exercise or 
other cause. It is to be treated by absolute rest and avoidance of 
excessive exercise, and by moderate amounts of food of a non-stimu- 
lating character. Wines and coffee should be forbidden, and a bella- 
donna plaster may be placed over the praecordium if the action of the 
heart is very excessive. Both palpitation of the heart and cardiac 
hypertrophy are favorably influenced in many cases by aconite or 
veratrum. 

Physicians who are in the habit of examining young men professionally 
will constantly have their attention called to a condition of shortness 
of breath on exertion, palpitation, or violent pulsation of the heart, and 
in some instances the development of severe symptoms which, at first 
glance, may seem to be those of true angina pectoris. In many of these 
youths there will be a history of the excessive use of tobacco, or 
that they have left college, where they indulged in severe ath- 
letic exercise, such as running or bicycle racing, and have entered 
business, where they lead a most sedentary life. In these cases the 
condition which exists is comparable to that which exists in a 
steamship whose engines are too strong for her hull. The heart, which 
has heretofore been supplying the body of an athlete with blood, now 
finds itself too strong for the sedentary individual. There is prob- 
ably no remedy which will give such good results under these cir- 
cumstances as aconite, in the dose of 1 minim (0.05) of the fluid 
extract or 5 to 10 minims (0.30-0.60) of the tincture three times a day, 
particularly if at the same time a good belladonna plaster about four 
inches square is applied over the praecordium. Many cases of tobacco 
heart, in which there is arhythmia, with an excessive cardiac impulse 
over the praecordium, with palpitation on exertion, will be benefited 
by aconite used in this way; but where the heart seems much depressed, 
so that the apex beat is feeble and the first and second sounds are not 
clearly heard, aconite will seldom, if ever, do good. 

In that form of functional cardiac disorder due to indigestion aconite 
is not capable of producing the results which are obtained in the cases 
which have just been mentioned. It may, however, be used as a remedy 
of value at the same time that the physician is directing his attention 
to the cause of the trouble — namely, the gastro-intestinal disorder, 
the treatment of which is foreign to this article. Here, again, a con- 
dition of cardiac feebleness contraindicates the employment of this 
drug. 

Passing to the employment of aconite in cases of true cardiac dis- 
ease, we find that a careful study of a certain number of cases will 
soon show the physician that this drug is capable of doing more good 
in some instances than is digitalis. 

The history of the following case illustrates this point: A man, 
aged nineteen, was brought to the hospital suffering from aortic 
obstruction, and as a result of this was attacked with dyspnoea on the 



692 DISEASES. 

slightest exertion, marked cardiac arhythmia, with palpitation, some 
giddiness, and a tendency to nose-bleed. He stated that in the early 
part of the year, and for several years preceding it, he had been a 
deck-hand on a coastwise vessel, where he performed hard manual 
labor, notwithstanding the condition of cardiac disease which was 
present, and of which he knew nothing. During this time he suffered 
from no symptoms indicating cardiac disorder. In other words, 
compensatory hypertrophy was complete. Because of the exposure 
incident to his work he was forced, under the advice of a physician, 
to earn his living on shore. He was not successful in obtaining em- 
ployment, and a prolonged period of muscular inactivity followed. 
As a consequence the cardiac hypertrophy, which had hitherto been 
compensatory, became excessive, and he suffered from marked cardiac 
palpitation, with disordered circulation in the extremities, and from a 
distressing cough. Early in the study of the case it was recognized 
that these disorders were due to the excess of cardiac hypertrophy, 
and not to failure in compensation, and, as a consequence, that a 
cardiac depressant was indicated rather than a cardiac stimulant in 
the shape of digitalis. He was given from 1 to 2 minims (0.05-0.1) 
of the fluid extract of aconite three times a day, and during the con- 
tinuance of this treatment was purposely confined to bed. At the 
end of a week so much improvement had taken place in his condition 
that he was allowed to rise and go about the ward as he wished, and 
after four weeks, the medicine being continued during this period, he 
was so improved that he was discharged from the hospital, with no 
other evidence of cardiac disorder than physical examination would 
show. 

When aconite is used, rest in bed is essential, in order that the 
heart may not be excited to great activity by exercise of the limbs, 
and also because the recumbent posture permits larger doses of the 
drug. 

An exceedingly useful treatment of valvular disease with or without 
excessive cardiac hypertrophy is rest in bed without medication. 
The results in some cases are often remarkable. 

Fatty heart occurs in two forms — that in which true fatty degenera- 
tion has taken place in the muscular fibre, and that in which there is a 
deposit of fat about the heart and between the fibres. Nothing of 
any importance can be done for the first state, except by the use of 
nitroglycerin or by the iodides to relieve arterial tension if it be too high. 
Strophanthus with or without nux vomica may be useful to relieve 
symptoms of cardiac distress. Much can be done for the second 
form. In neither form is digitalis of much value. If given, it should 
be combined with nux vomica, or nux vomica may be given alone in 
full doses. The patient suffering from the second form of heart 
trouble is nearly always obese, and should abstain from fats and rich 
foods, from all sweet wines and malt liquors, from sugars and milk, 
and at the same time take exercise. At first this treatment may 



HEART DISEASE. 693 

cause dyspnoea, but by gradually increasing the severity of the exer- 
cise much can generally be effected in the end, with marked improve- 
ment in the cardiac action. (See Obesity.) 

Heart disease associated with failure of the muscle may not only be 
treated with drugs, but with other remedial measures, such as gentle, 
active exercise, passive exercise, and baths, the latter being given with 
care to avoid too great shock and for the purpose of improving the 
general circulation. 

Within a few years a method has been brought forward by 
Schott, of Nauheim, Germany, which consists in treating patients 
with feeble hearts by means of movements and baths of water derived 
from the springs at Nauheim. The movements are so-called resist- 
ance movements, the patient slowly flexing and straightening his 
limbs and neck against gentle resistance on the part of an attendant. 
By this means the circulation of blood and lymph in the tissues is 
aided without tiring the heart. These resistance exercises do not, 
however, agree with all cases. In persons with very feeble hearts 
gentle massage is far better. The rule should be never to give 
enough exercise or massage to cause acceleration of the respiration or 
marked increase in the action of the heart. Very feeble cases should 
have the massage first, the exercise next, and the baths last. 

Before considering the use of the Nauheim bath it is necessary 
to have a clear conception of what it is and the methods by which it 
does good. There are six springs at Nauheim, of which three are 
used for bathing and three for drinking purposes. The latter are not 
of great importance and do not form part of the "cure" in the strict 
sense of the word, although the water from the "Kur" and "Karls- 
brunnen" springs are sometimes sipped in the morning before break- 
fast for their laxative effect. 

The bathing waters are derived from three sources: No. 12, or 
Friedreich Wilhelms Quelle; No. 7, or Der Grosse Sprudel; and a 
new one, called No. 14. The water of all these is very heavily charged 
with carbonic acid by nature. So great is the pressure that the water 
is forced upward as high as fifty feet from a vertical pipe-nozzle. In 
the case of springs 7 and 12 the delivery pipe permits the water to 
shoot upward, and it then falls back into adjacent tanks, so that dur- 
ing its rise and fall a large amount of gas is lost, and much of the lime 
and iron held in solution is precipitated in the tanks. This water is 
led to bath-tubs, and if the patient is feeble and the "cure" is just 
beginning, it is often diluted with plain water and sometimes heated 
This forms the Thermal Sool-bad. 

Other baths are supplied by pipes which carry the water directly 
from the earth without the gas being allowed to escape in any quantity. 
This water sparkles as does soda-water, and is called the Sprudel-bad. 
Still another bath is provided in which there is an outflow opening as 
well as an inflow opening, and in which the patient sits in a tub 
into which freshly charged water is rushing as fast as it runs out. 



694 DISEASES. 

This is called the Strom-bad. These baths are all therapeutically 
powerful, but, naturally, the first is not so active as the last. 

The therapeutic value of these baths depends upon their ability to 
cause dilatation of the peripheral capillaries, which thereby relieves 
internal congestions and enables the heart to pump blood more easily 
through the capillaries. They also stimulate the heart by reflex 
nervous action. When a patient is suffering from grave cardiac 
failure depending upon valvular disease, with grayness of the face and 
cyanosis of the lips, the baths should be begun very cautiously, using 
the Thermal Sool-bad. Even then, for the first minute after the 
patient enters the bath, he may seem more oppressed than before. 
But in the next few minutes his apprehension passes away, and a 
feeling of warmth and comfort develops, so that after ten or fifteen 
minutes it will be found that his skin is uniformly reddened wherever 
it has been in contact with the gas and water. The time which the 
patient spends in the bath should be prescribed by a local physician. 

After the bath the patient is carefully dried by an attendant, and 
must rest absolutely in a reclining position for at least one hour. At 
first the bath is used only every two or three days. As the patient 
gains strength the baths are gradually increased in length and fre- 
quency, and finally additional mother-salt obtained by the evaporation 
of the water is added to the natural water in the tub. Later, when 
still stronger, the patient takes the foam, or "strom" bath, in which 
the gas is present in such quantities that the water foams. This is, of 
course, very stimulating and dangerous for a weak patient with poor 
reaction. When the patient recovers enough to use gentle walking 
exercise this is permitted, the resistance exercise being employed on 
days between the baths as a rule. 

These baths may be prepared artificially and are resorted to in this 
country, being now installed in several watering-places. The formulae 
for making the baths are as follows in each 40 gallons of water at 
95° F.: 

Bath No. 1: sodium chloride, 4 pounds; calcium chloride, 6 ounces. 

Bath No. 2: sodium chloride, 5 pounds; calcium chloride, 8 ounces. 

Bath No. 3: sodium chloride, 6 pounds; calcium chloride, 10 ounces. 

Bath No. 4: sodium chloride: 7 pounds, calcium chloride, 10 ounces; 
sodium bicarbonate, \ pound; hydrochloric acid (25 per cent.), 12 
ounces. 

Bath No. 5: sodium chloride, 9 pounds; calcium chloride, 11 ounces; 
sodium bicarbonate, 1 pound; hydrochloric acid, \\ pounds. 

Bath No. 6: sodium chloride, 11 pounds; calcium chloride, 12 
ounces; sodium bicarbonate, 2 pounds; hydrochloric acid, 3 pounds. 

The alkali should always be slightly in excess unless a porcelain or 
papier-mache tub is used. 

A small bottle containing the hydrochloric acid is submerged at the 
bottom of the tub, uncorked, and its contents allowed to escape into 
the water, in which effervescence at once occurs, the patient entering 



HEMORRHAGE. 695 

the bath at that time. The numbers of the baths simply indicate 
different strengths. Patients may never use them stronger than that 
represented by the second or third formula. Toward the close of the 
treatment the temperature may be lowered to 85° F. 

Recently Tyson has used a series of perforated iron tubes placed 
upon the bottom of the tub under a wooden rack. These tubes are 
connected to a large cylinder containing carbonic acid gas, which is 
allowed to bubble through the water, thus supplanting the crude 
method of producing the gas by the acid just named. The tub 
should be of wood. 

These baths are indicated chiefly for feeble hearts, as already stated. 
Thus, if there be cardiac dilatation resulting from such depressing 
causes as epidemic influenza, they often prove useful. So, too, in 
cardiac neuroses and functional disorders dependent upon lack of vaso- 
motor tone they are serviceable. In valvular disease with perfect 
compensation they are not needed, and when compensation is ruptured 
they are dangerous, owing to the production of syncope. If the bath 
acts favorably, the pulse becomes stronger and fuller, the heart action 
slower, and the physical signs of cardiac dilatation disappear. En- 
gorgement of the liver also is relieved. As with all other methods 
of treatment, the cases submitted to this treatment should be care- 
fully selected, as it has its therapeutic limitations. This treatment 
does not necessarily exclude the use of drugs. A liberal vegetable 
diet, with small amounts of meats, is given. 

HEMORRHAGE. 

{Including Menorrhagia, Metrorrhagia, Haemoptysis, H&matemesis, 
Intestinal Hemorrhage, Hematuria, and Post-partum Hemorrhage.) 

Under this heading will be considered all forms of hemorrhage 
which we may endeavor to control by drugs or measures not directly 
surgical in their scope, with the exception of epistaxis, which has already 
been spoken of. 

Whenever a hemorrhage can be arrested by the application of a 
ligature or by compression, as in a cut of the finger or some similar 
wound, no styptic should be used. Styptics are employed for the 
double purpose of constringing the tissues and coagulating the blood, 
and, in consequence, form coagula which tend to make a septic 
mass about the wound. In their place the physician should resort to 
a compress soaked in some antiseptic liquid or filled with some disin- 
fectant powder, and if this fails to control the bleeding, then ligation 
of the bleeding vessel becomes necessary. 

Where the bleeding point cannot be reached by direct compression 
or for ligation, the use of packing and of astringents is advisable, and 
drugs which are antihemorrhagic may be used by the mouth. 

In all forms of hemorrhage in which the flow has been sufficiently 
great to endanger the patient's life, resort should be had to hypoder- 



696 DISEASES. 

moelysis or to transfusion. (See Hypodermoclysis and Transfusion, 
Part III.) 

Recently gelatin has been employed externally to control hemor- 
rhage, and has been given hypodermically to aid in the coagulation 
of blood in bleeding parts which cannot be reached directly. Lancer- 
eaux and Paulesco use the following formula: 

1^ — Gelatini, 

Sodii chloridi aa gr. cl. (10.0). 

Aquae destillat Oij (1000 c.c). 

This mixture is sterilized by heat and 2 ounces (60 c.c.) are injected 
into the tissues of the thigh or buttock. 1 This is increased to 5 ounces 
(150.0) in later injections if they are needed. Usually one or two 
doses are sufficient. A like solution may be used locally to check 
oozing. 

Menorrhagia is an excessive flow of menstrual blood, either excessive 
in quantity during two or three days or continuing an unusual number 
of days; while metrorrhagia is a state in which bleeding takes place 
from the uterus independently of menstruation and at any period of 
the month, or even after the menopause has occurred. 

Menorrhagia is not to be determined by the amount of the flow, 
but by whether the loss is sufficient to cause ill health or to indicate 
disease. In some cases it is a means of relieving plethora. 

When the physician decides that something should be done to 
improve the condition of the patient, when suffering from either 
menorrhagia or metrorrhagia, it is necessary for him to find out 
whether a polypus, fibroid growth, endometritis, or other form of 
uterine disease is directly responsible for the trouble, and in the mean 
time to employ drugs known to act favorably upon uterine hemor- 
rhage. The most prominent of these drugs are ergot and oil of erigeron, 
the first being the more active and the best remedy for active bleeding, 
the second better for oozing and for cases where there is a continual 
"show." The fluid extract of ergot may be given in varying dose, from 
10 to 60 minims (0.60-4.0), according to the necessities of the case, 
and the oil of erigeron in capsule in the dose of from 3 to 5 minims 
(0.20-0.3), or, if capsules cannot be had, the physician may employ 
the oil in an emulsion made by using syrup of acacia or other similar 
substanc?. Locally, sterile cotton wet with a sterile solution of adre- 
nalin chloride (1 : 5000) may be employed. 

Where menstruation is irregular and the menorrhagia is almost 
a metrorrhagia, bromide of potassium or sodium in the dose of 10 
grains (0.60) several times a day is often very serviceable. The 
water of hamamelis in the dose of 1 drachm (4.0) three times a 
day is almost as useful. Cannabis indica, if an active sample is 
obtainable, is also said to be of service, but the writer has never used 

1 The gelatin should be boiled at least an hour, as tetanus spores are often present and are not 
killed by being exposed to heat for a short time. 



HEMORRHAGE. 697 

it to any extent. Oil of cinnamon in the dose of J drachm (2.0) is 
very efficacious in the slow oozing of some cases where erigeron cannot 
be used or obtained. Sometimes, where congestion of the pelvic 
viscera is the cause of the trouble, dry cups over the sacrum give relief. 
Haemoptysis,. or hemorrhage from the lung, is usually due to tuber- 
cular ulceration of a small or large bloodvessel, and the life of 
the patient depends more upon the rapidity with which a clot 
naturally forms than upon the skill of the physician. Though text- 
books order atomized solutions to be inhaled and other remedies to 
be taken by way of the lung, in most cases these measures will be 
found impracticable, because the nervousness of the patient and the 
constant cough will not permit of inhalations to any extent, and even 
if a full breath is taken, it generally increases the bleeding and cough- 
ing. The only occasions in which inhalations of styptics are of 
service are those in which the hemorrhage is just beginning or is so 
slight as to streak the sputum or to be at least thoroughly mixed with it. 
Even in these cases little if any of the drug reaches the bleeding spot. 
The solutions to be so employed must be used in a vaporizer which will 
throw a fine vapor — sufficiently fine to enter the smallest air-tubes with 
the inspiratory wave of air. A very good fluid is one made from 
Monad's solution, as follows: 

1$ — Liquor ferri subsulphat gtt. xx to xxx (1.3-2.0). 

Aquae dest f§iv (120.0).— M. 

S. — Use in an atomizer every few minutes. 

Or the following: 1 

1$ — Acid, tannic gr. xx (1.3). 

Glycerini f5ij (8.0). 

Aquae dest q. s. ad f§iij (90.0). — M. 

S. — Use in a vaporizer. 
Or, 

ty — Aluminis ■ . . . gr. vj (0.4). 

Aquae dest fgiij (90.0).— M 

S. — Use in an atomizer. 

Some clinicians advise that the patient should swallow, whether 
the hemorrhage be acute or not, not less than 1 to H drachms (4.0-6.0) 
of the fluid extract of ergot, or a solution made by adding 20 grains of 
gallic acid to 1 ounce (1.3-30.0) of water; but it is difficult to under- 
stand how they can be of service, and when bleeding ceases after their 
use the arrest is probably a coincidence and not due to the drug. 
Tannic acid given by the stomach is not so good as gallic acid, because 
it must be absorbed and changed into gallic acid before it can reach 
the bleeding point through the circulation. On the other hand, 

1 If the Monsel solution does not stop the hemorrhage, tannic acid will probably fail; but, 
more important, the two should not be used together, as they are incompatible and the tannate 
of iron will be formed, which is as black as ink. 



698 DISEASES. 

tannic acid, if locally used, is the better, for it constringes the tissues 
and forms a clot, whereas gallic acid does not coagulate the blood. 

Hemorrhage from the lung must be regarded as any other hemorrhage. 
The object of the physician is not to stimulate the heart and vasomotor 
system, thereby increasing the leakage from the bleeding vessel, but to 
lower the arterial pressure to as low a point as is safe. The rule to 
follow is best stated as follows, if the hemorrhage has been severe and 
the patient is feeble: place his head lower than the feet and apply 
Esmarch bandages to the limbs to keep the blood in the vital parts as 
much as possible. The use of stimulants can only increase the hemor- 
rhage by increasing the pumping power of the heart and by dislodging 
the clot from the eroded bloodvessel. 

Daremburg and Yeo have employed ice or ice-cold compresses to 
the scrotum or vulva in cases of haemoptysis, and claim good results 
from this use of cold. 

To allay nervous excitement many writers advise that a hypodermic 
injection of morphine should be used. Chloral and the bromides are 
often better remedies for this purpose, and should be given by the 
mouth, or, if vomiting is present, they should be given by the rectum, 
dissolved in starch- water. (See Chloral and Bromides.) 

Sometimes the patient can point directly to the spot where he thinks 
the hemorrhage exists, and under these circumstances a dry cup or a 
piece of ice placed over this point may perhaps prove useful by causing 
a reflex contraction of the deeper bloodvessels. 

After an attack of haemoptysis there is great danger in many cases 
of a traumatic pneumonia being set up by the presence of the extrava- 
sated blood. This should be combated by the use of a carefully regu- 
lated diet, and the reduction of any arterial excitement by small doses 
of aconite in persons not weakened by advanced disease* or bleeding. 
Complete rest in bed is to be insisted on, and no stimulants allowed in 
food or drink unless the weakness of the patient requires them. 

Haematemesis. — This depends either upon some injury to the stom- 
ach, or, much more commonly, upon gastric ulcer, cancer, or cirrhosis 
of the liver, and is one of the easier of the so-called "internal hemor- 
rhages" to treat, because by ordering the patient to swallow styptic 
drugs we can act directly upon the bleeding surface. 1 Adrenalin in 
the dose of a drachm (4.0) of 1 : 1000 solution may be given, and ice 
should be swallowed frequently, or 3 minims (0.20) of Monsel's solution 
in half a tumblerful of water may be used every fifteen minutes till 
four doses are taken. Tannic acid may be given instead in the dose of 
20 grains to a drachm (1.3-4.0), but the two should never be given 
at the same time. (See foot-note to p. 697.) Monsel's salt may 
be given in pill in the dose of 2 to 3 grains (0.12-0.20). The acetate of 

1 Haematemesis also ensues as a result of swallowing blood which has escaped into the 
mouth or nasopharynx, and this symptom is sometimes induced by malingerers in order to 
further their ends. These forms of haematemesis should, of course, be separated from those 
dependent upon some lesion in the stomach itself. 



HEMORRHAGE. 699 

lead is also of value in pill form in the dose of 2 to 3 grains (0.12-0.20) 
with morphine or opium. Tincture of the chloride of iron, the sul- 
phate of iron, turpentine, ipecac, ergot and hamamelis may all be 
used, the last three particularly in slow or passive hemorrhages. 
Sometimes nitrate of silver in the dose of \ grain (0.015) in pill 
form is of service if the hemorrhage is a slow one. Bandages to the 
extremities and external heat should be applied. 

Hemorrhage from the bowel is to be treated according to its point 
of origin. If in the small intestine, as from ulceration of Peyer's 
patches or other glands, the medicines must be used by the mouth; if 
it be from the colon or rectum or from hemorrhoids, medication must 
be by way of the anus. In any case rest in bed is essential. 

Hemorrhage of the first class is best combated by the application of 
a small ice-bag to the belly and by the use of Monsel' s salt (ferri 
subsulphas): 3 grains (0.20), made into a pill, should be given every 
half-hour or oftener, the pill being coated with salol so that it may 
reach the intestine without being dissolved in the stomach. Ergot 
has been resorted to, but is of doubtful value even if used hypoder- 
mically (see Ergot); but tannic acid may be given with advantage in 
large amount in solution if the Monsel salt is not obtainable. The 
other remedies which are of service are sulphuric acid in the dose of 
5 to 10 minims (0.3-0.60) in water in acute or passive bleeding, or 
turpentine given in capsule, or, better still, in emulsion with acacia in 
the dose of 10 minims (0.60) every half-hour, particularly when the 
hemorrhage is not active. Chloride of calcium is useful (which see). 
Acetate of lead and camphor in the following pill may be of service 
in some cases : 

1^ — Plumbi acetatis gr. v (0.3). 

Camphorse gr. x (0.60). — M. 

Ft. in pil. No. v. 

S. — One pill every hour. 

Where the hemorrhage is dependent upon ulceration of the colon 
or rectum injections are to be resorted to. These are both styptic and 
curative, the styptic injections being particularly useful when the 
bleeding is to be stopped at once, the others where it is sought to 
remove the condition producing the trouble. 

To the first class belong alum, sulphate of copper, MonsePs solution, 
sulphate of iron, tannic acid, and cold water. In the second, we find 
nitrate of silver, the sulphates of copper and iron, and the chlorate of 
potassium. 

The alum solution used should be fairly strong, 10 grains to the 
ounce (0.60-30.0) ; the copper, 5 grains to the ounce (0.3-30.0) ; 
the Monsel salt, 10 grains to the ounce (0.60-30.0) ; or J to 1 drachm of 
Monsel's solution to each 2 ounces (2.0-4.0 : 60.0) of water. The tannic 
acid should be used in the strength of 20 grains to the ounce (1.3-30.0) 
of water and glycerin. When chlorate of potassium is used, it should 
be employed in saturated solution in small injections (25 grains to the 



700 DISEASES. 

ounce [1.60-30.0]), or in weaker solution if the injection be a large 
one (10 grains to the ounce [0.60-30.0]). Another useful drug, if the 
site of the hemorrhage can be reached, is adrenalin chloride in the 
proportion of 2 drachms of the ordinary 1 : 1000 solution in a half-pint 
of normal saline solution. 

These injections should be carefully given, and the success or failure 
attending the treatment of these states depends as much upon the 
technique of the operation as upon the particular medicinal substance 
employed. It should never be forgotten that an injection designed for 
local medication should be as small in bulk as circumstances will per- 
mit. Thus, in inflammation of the rectum the amount of the injected 
liquid should not be above 4 ounces (120.0) at the utmost, and prefer- 
ably 2 ounces (60.0) unless the diseased area is high up. An enema 
is given in bulk so as to cause distention and excite the bowel to move- 
ment, whereas by a medicinal injection no movement is desired. 
Again, the apparatus for sending in the fluid ought not to be a "fam- 
ily" or ordinary syringe, but a fountain syringe, the pressure being 
hydrostatic. This may be dispensed with if the injection be small 
and intended only for the lower part of the rectum, but it is indispen- 
sable if the injection is designed to reach the upper part of the colon. 
The entrance of the liquid should always be gradual and easy. If 
resistance is met with, the pressure must be overcome, not by force, 
but by waiting a moment until it passes off. When the entire colon 
is to be flooded, at least a gallon of warm liquid will be needed. In 
these cases those drugs which are readily absorbed and liable to pro- 
duce poisonous symptoms are not to be used except in small amounts. 
(See Enteroclysis, Part III.) 

Where the injection is to reach high up into the bowel the patient 
should be put in the lithotomy position with the buttocks elevated. 

Sometimes in dysentery the injection of a pint to a quart of ice-cold 
water has a most favorable effect upon the bloody purging. 

Whenever a medicated injection is to be used for the cure of ulcers 
which cause hemorrhage, the entire tract which is to be treated should 
be washed out with pure water or with a saline or soapy liquid, in 
order to dislodge mucus and feces, which prevent the medicament 
acting on the bowel wall. 

Hosmaturia is a condition in which blood appears in the urine, and 
may be divided into two classes — that in which the blood comes from 
the kidney or bladder, and that in which it comes from the urethra. 
In the first class the blood is always well mixed with the urine, which 
is changed in color from its decomposition, and the blood is present 
either during the entire act of urination or just at the end of the act. 
In those instances in which the blood is in the first part of the stream 
it arises in the urethra, is nearly pure, and not well mixed with the 
urine. 

If the blood is due to the presence of an acute nephritis, the kidneys 
need treatment, and for directions as to this point the article on Acute 



HEMORRHAGE. 701 

Nephritis should be read; while, if the hemorrhage is due to the pres- 
ence of a lesion in the bladder, the directions governing the use of 
turpentine, erigeron, or ergot, as given for Menorrhagia and Metror- 
rhagia, should be followed, or if any morbid growth be present it should 
be removed. Sometimes 5 to 10 grains (0.30-0.60) of camphor in 
divided doses are of service, given in pill form, while in others can- 
nabis indica is efficacious. Gallic acid in 20-grain (1.3) doses is 
valuable. 

If the hemorrhage is alarming, injections of adrenalin chloride 
(1: 5000) may be used; or astringent washes, such as 2 or 3 grains of 
alum to the ounce of water, may be injected into the bladder. It 
must be remembered, however, that alum fills the bladder with clots, 
which are not readily passed and are liable to become septic. 

A useful prescription for internal use is: 

If— Acid, gallic oj (4.0). 

Acid, sulphuric, dil f5jj (8.0). 

Aquae destillat q. s. ad f§iij (90.0). — M. 

S. — Teaspoonful (4.0) in water every four hours. 

Malarial infection is sometimes accompanied by hematuria or 
hemoglobinuria. The cause is obscure, and an immense amount of 
discussion has taken place as to its proper treatment. Many physicians 
assert that the use of quinine in these cases produces disastrous results; 
others claim that the drug is most valuable. The value of quinine 
consists, undoubtedly, in its ability to prevent other attacks, rather 
than to relieve that already present or its result — the hematuria. If 
an examination of the blood shows the presence of the estivo-autumnal 
parasite, quinine is to be freely used; but if not, it is to be avoided. 
Personally the author believes that malarial hematuria and hemoglo- 
binuria will ultimately be found to depend upon very different causes. 
In some cases it will be found that the malarial parasite is the cause 
of the disease. In other instances it will probably be discovered 
that an entirely different organism belonging to the same general type 
of parasites is responsible for the development of this dangerous 
and much dreaded complication. (See Cinchona, Part II.) Thio- 
sulphate of sodium is a most useful remedy in malarial hematuria 
in the dose of 5 to 15 grains (0.3-1.0) every five hours. Many prac- 
titioners use as much as a drachm of thiosulphate of sodium every 
two hours till purgation takes place, give morphine and atropine 
hypodermically to relieve pain and quiet the stomach, apply cups over 
the kidneys, and give water to drink so as freely to flush the kidneys. 

Post-partum hemorrhage is to be controlled by the use of abdominal 
friction and kneading or grasping the dilated uterus through the 
relaxed abdominal wall; by the use of drachm doses of the fluid 
extract of ergot or a wineglassful of the wine of ergot, or by the 
hypodermic use of ergot aseptics ; and by irritation of the uterine wall 
by passing the hand, which must be absolutely aseptic, up through 



702 DISEASES. 

the vagina into the uterine cavity. In other cases injections of sterile 
water as hot as can be borne may be resorted to. 

In all forms of local hemorrhage from small vessels adrenalin 
chloride is to be thought of as a local application or as a remedy 
suited for use by hypodermoclysis. (See Suprarenal Gland, Part II.) 

HEMORRHOIDS. 

Hemorrhoids are vascular dilatations of capillaries, arteries, or 
venules situated outside or inside of the sphincter ani, or are com- 
posed, in the case of what are called external piles, of tags of skin 
which are more or less vascular and become troublesome when inflamed. 

The internal pile if large, is apt to prolapse and to become strangu- 
lated by the sphincter muscle. It is covered with mucous membrane, 
and is sometimes very small or like a mulberry in shape, consisting 
of a tuft of capillaries, a loop of an arteriole, or of a venule. The 
capillary or arterial hemorrhoid is apt to be bright red, and to bleed 
profusely when touched or when scraped by hard feces. The venous 
tuft also bleeds, but not so freely, and the blood is not so bright in 
color. In cases in which the hemorrhoids "come down" — that is, 
pass out through the anus, so being in danger of becoming strangu- 
lated — the protruding mass should be washed with cold water, 
thereby at once cleansing it and reducing its congestion, and then 
gently pushed back with the fingers, which should be well oiled. 
In some cases it is advantageous to push gently into the rectum a 
cold rectal speculum, which will not only replace the piles, but also 
contract their walls and displace the blood with which they are filled. 
Care should be taken that an external hemorrhoid is not mistaken 
for an internal pile, since if an external growth is pushed through the 
sphincter, it also becomes strangulated. 

The treatment of internal hemorrhoids is to a great extent identical 
with that of the external variety. A suppository may be used, made 
up as follows, if there is a tendency to slight hemorrhage: 

& — Acid, gallic . gr. xx (1.3). 

Extract, opii ......... gr. j (0.06). 

Extract, belladonnse gr. ij (0.12). 

01. theobromse q. s. — M. 

Ft. in suppos. No. x. 
S. — Use one every night. 

In place of this, water of witch-hazel extract may be injected into 
the rectum in the quantity of 1 or 2 ounces (30.0-60.0). 

If the hemorrhage is profuse, the physician should use a speculum, 
find the bleeding point, and touch it with strong nitric acid, followed 
by the suppository named above. If this is done, the bowels should 
be confined for some days until the spot under the slough made by 
the acid can heal. 

If the prolapsed hemorrhoid is inflamed and difficult of reduction, 
the following ointment of Mathews may be ordered : 



HEMORRHOIDS. 703 

ly — Coc&iaae gr. xij (0.8). 

Iodoformi oj (4.0). 

Extract, opii sjr. xxx (2.0). 

Petrolati oj (30.0).— M. 

S. — Use as a salve. 

Note that this prescription calls for cocaine, not cocaine hydro- 
chlorate. The reason for this is that the salt of cocaine does not act 
well when mixed in an ointment. 

If the pile still refuses to be reduced, place the patient in bed and 
apply a hot compress wet with adrenalin chloride solution (1:2000). 
If this fails, operation is demanded. 

The treatment of external piles themselves consists in the main- 
tenance of the most rigid cleanliness. Immediately after each move- 
ment the parts should be thoroughly washed by means of a sponge 
dipped in cold water, or, better still, by the use of the bidet or a nozzle 
attached to a fountain syringe or to the general water-supply. (See 
Cold, Part III.) After they are thoroughly cleansed, it is well to 
bathe them with distilled extract of hamamelis. Often it is advisable 
to precede the regular daily evacuation by a rectal injection of cold 
water to soften the feces, and, more important still, to decrease con- 
gestion. If the inflammation of the external piles is very acute, the 
patient should be placed in bed and the cold injections frequently 
repeated or hot compresses applied to the anus. After this a lotion 
of lead-water and laudanum — laudanum foss (16.0) to dilute lead- 
water fSij (60.0) may be used. 

The injection of phenol into hemorrhoids is a dangerous practice, 
and, if employed, only 1 drop is to be used. 

In addition to these applications there are important general rules 
to be observed. 

The patient's habits should be so arranged that the daily act of 
defecation is at night before going to bed, rather than in the morning, 
as under these circumstances the rest in bed relieves congestion and 
soreness, which the maintenance of the erect posture might aggra- 
vate. Plethoric individuals should not use upholstered chairs, as the 
heat of the body relaxes the rectal tissues. A cane-seated chair is 
best, or an air-cushion with a hollow centre. The liver plays a 
most important part in relation to hemorrhoids, and, if it is congested, 
congestion of the hemorrhoidal veins is very apt to ensue. The con- 
nection between the liver and the hemorrhoidal plexus is most inti- 
mate, since this plexus is formed by the superior hemorrhoidal veins, 
which are branches of the inferior mesenteric, and the middle and 
inferior hemorrhoidal veins, which terminate in the internal iliac. 
The portal venous system is composed in part of the inferior mesen- 
teric vein, and any obstruction to venous flow in the liver at once 
results in engorgement of the hemorrhoidal plexus. 

(For the surgical treatment of piles reference must be made to 
surgical works.) 



704 DISEASES. 

HEPATITIS. 

(Acute and Chronic Hepatitis and Hepatic Abscess.) 

Inflammation of the liver may be produced by many causes, such as 
injuries, cold, exposure to high temperatures (as in the tropics), syphilis, 
and the presence of any infectious disease or of parasites. It may also 
arise from alcoholism. The acute form is rarely directly produced 
by syphilis, although it may arise indirectly from this disease, being 
due to the absorption of septic materials into the circulation from 
wounds or sores. The hepatitis of hot climates is generally subacute 
or chronic. The pain, swelling, and general symptoms of the acute 
form of inflammation of the liver are described thoroughly in the 
text-books on the practice of medicine. The measures commonly 
adopted for the relief of the symptoms and the disease itself are of two 
kinds: the first, medicinal; the second, dietetic. 

The patient, if the attack be acute or severe, will commonly be 
found in bed, owing to the pain and fever, but if not he must be placed 
in bed and kept in a recumbent posture. Over the surface of the 
right hypochondrium may be placed a number of small cantharidal 
blisters; or, if this is not possible, a large mustard plaster is to be 
used. Sometimes hot cloths applied over this area are equally 
efficient. At the same time, if the bowels are confined, a saline 
purgative, such as magnesium sulphate, should be given, and it is 
often wise to precede it several hours by small doses of calomel 
given in fractional doses. The kidneys must be kept active by spirit 
of nitrous ether and citrate of potassium, or by any one of the diuretic 
waters, such as Vichy, in moderate quantities. 

If a single hepatic abscess develops, 1 the best thing to be done is to 
expose the liver and open it. Very frequently the inflamed organ will 
form so strong an attachment with the peritoneal coat of the abdominal 
cavity that a bistoury must be used to free the pus. Any constitutional 
evidence of the presence of pus, as by night-sweats, hectic, or rigors, 
is a sign for immediate interference with the purulent collection. If 
amoebic dysentery exists, it must be cured as rapidly as possible by 
the measures generally employed for this purpose. (See Dysentery.) 
Multiple hepatic abscess is beyond our measures of relief. 

The diet during the early and later stages of acute hepatitis should 
be limited to those articles of food which are easily digested and assim- 
ilated, and rich or greasy dishes are to be excluded. "Strong foods," 
as meats of all kinds, particularly beef, pork, and mutton, are to be 
sedulously avoided. All spices in the food must be forbidden, and 
alcohol utterly tabooed. If koumyss cannot be had, the patient may 
be fed on peptonized milk or pancreatized oysters. (See Part III.) 
After the abscess develops the same recommendations are to be fol- 

1 It is well to recall that many cases of hepatic abscess are now known to be due to dysentery, 
and that the diseased state of the lower bowel may result in infection of the liver. 



HICCOUGH. 705 

lowed, and the diet is to be as supportive as possible, small doses of 
quinine and iron being used. 

In the treatment of the subacute or chronic hepatitis of hot climates 
no remedy compares to freshly prepared strong nitromuriatic acid, 
used both externally and internally. The acid should be a deep 
lemon color, and be mixed with water only when about to be taken 
in the dose of 3 or 4 minims (0.20-0.25) three times a day. This rem- 
edy is contraindicated in acute hepatitis, because it acts by stimulating 
the organ, and would only increase the severity of the acute form of 
the disease if administered at this time. Externally, it is to be used by 
mixing it with water and applying it by means of a flannel wrung out in 
the mixture, or by placing it on spongiopiline in the proportion of 
from 1 to 3 fluidrachms to the pint (4.0-12.0:480 c.c.) of warm water 
and applying it over the liver. If 3 fluidrachms (12.0) irritate the skin 
too greatly, the smaller quantity should be employed. This applica- 
tion causes a tingling of the skin and a localized sweat. 

The hepatitis due to syphilis generally shows itself as a cirrhosis, 
and is to be treated by antisyphilitic measures. (See Syphilis.) If 
ascites develops from cirrhosis, the liquid is to be withdrawn, and 
frequent aspirations, as often as the liquid returns, have been known 
to result in apparent cure or arrest of the disease. In all forms of 
chronic hepatitis iodide of potassium is a useful remedy in the dose of 
from 5 to 10 grains (0.3-0.60) three times a day, and larger amounts 
should be used if the condition be due to syphilis. 



HICCOUGH. 

Hiccough is an affection arising from many causes, depending upon 
irritability of the nerves supplying the diaphragm as a result of gastric 
irritation, nervousness, uraemia, and as a complication of several 
exhausting diseases, such, for example, as typhoid fever. 

The mechanism of its production rests upon the sudden contraction 
or descent of the diaphragm, whereby a vacuum is formed in the chest 
into which the outside air attempts to rush, but is prevented from 
doing so by a sudden closure of the glottis, the peculiar sound of the 
hiccough being thus developed. Generally the symptom stops of 
itself, but it may become continuous and excessive. 

The remedies to be employed are used according to the cause of 
the disorder. If there be gastric or intestinal irritation, the irritating 
matter must be removed by emetics or purges, and nervous and local 
sedatives used. A drachm (4.0) of spirit of chloroform does good 
in many cases, and tincture of capsicum may be employed in other 
instances, say 5 or 10 minims (0.30-0.60) well diluted. Children 
should have only \ to 1 minim (0.025-0.05) of the tincture, well diluted. 
Spirit of camphor, or the tincture of valerian, in the dose of 1 drachm 
(4.0), may be serviceable, and Hoffmann's anodyne is peculiarly 
efficacious in the dose of 1 drachm (4.0) in ice-water. In the hiccough 

45 



706 DISEASES. 

of typhoid fever nothing compares to musk, 10 grains (0.60) by the 
rectum, and, if this cannot be used, oil of amber may be given by the 
mouth in the dose of 5 to 10 minims (0.3-0.60) in capsule or emulsion, 
and followed by a drink of milk to prevent irritation of the stomach. 
Nitrite of amyl may also be inhaled. When hiccough is so persistent 
as to endanger life it must be controlled by the use of bromide of 
sodium and deodorized laudanum given by the bowel. (See article 
on Vomiting, for directions.) 

Where external remedies are resorted to, ether thrown in a fine 
spray on the epigastrium may check an attack. 

In cases where the affection comes on after meals and is due to 
indigestion, a course of tonic treatment will often give relief. Thus 
nux vomica in pill or tincture, accompanied by some dilute mineral 
acid, such as hydrochloric or nitric, may be employed, or, if the 
stomach is acid, 

T^ — Sodii bicarb 5j (4.0). 

Tinct. nucis vom f 5j (4.0). 

Tinct. cardamomi . . . . q. s. ad f Siij (90.0). — M. 
S. — Teaspoonful (4.0) before each meal. 

If the symptoms are due to uraemia, a hot pack may be found of 
service, unless contraindicated by advanced depression and systemic 
weakness. Even in the presence of these symptoms it may be advis- 
able to resort to this measure, protecting the patient against depression 
by a hypodermic injection of strychnine. 

INCONTINENCE OF URINE. 

Incontinence of urine may be classified either according to its forms 
or the methods of its treatment. 

Four varieties may be recognized as occurring separately, although 
all of them may occur in one case. There are cases where the bladder 
fails to hold the urine day or night, those in which the incontinence 
is only nocturnal, and those in which it occurs only upon some nervous 
start or in which the sphincter becomes relaxed from general atony. 
The first of these occur in children, the last in adult females. A 
fourth form of incontinence depends upon paralysis arising from 
centric nervous disorder or from paralysis due to retention and con- 
sequent paralytic distention. 

Taking up the consideration of the first forms — namely, those 
occurring in children, in which the trouble is generally nocturnal— 
the complete history and the present condition of the case must be 
discovered. Many of the most obstinate cases will yield when the 
urine is made constantly clear and mild by the use of alkalies, and 
others will recover upon the removal of worms from the vagina, which 
have crawled there from the rectum, or upon circumcision of a redun- 
dant prepuce, particularly if this be tight and smegma and urine be 
found back of it in large or small quantity. The cause of the incon- 



INCONTINENCE OF UBINE. 707 

tinence in both these conditions is reflex irritation of the bladder-walls, 
by irritation at the end of the penis or in the vagina, and the reason 
that alkalies do good is that they render the urine, which is concen- 
trated and irritating, dilute, alkaline, and mild. Belladonna in these 
cases is rarely, if ever, curative, and is at most only palliative, the 
condition returning as soon as the passing off of the effects of the drug 
permits the irritation to be felt by the nerves of the bladder. After 
alkaline diuretics have been used belladonna is, however, very valuable. 
Where the urine is concentrated and dark in color the following pre- 
scription is always useful: 

]$— Potassii citratis 5ij (8.0). 

Spt. setheris nitrosi ...... foij (8.0). 

Aquae dest q. s. ad f §iij (90.0). — M. 

S. — Dessertspoonful (8.0) every four hours in a tablespoonful (15.0) of water. 

As the urine becomes clear after several days a few drops of tincture 
of belladonna may be added to the mixture; but if a moderate amount 
is not sufficient, it must not be increased, as belladonna will not cure 
the condition, and may make the urine concentrated — a condition 
directly opposed to that which is wanted. 

In other instances — and these are by no means rare — the urine is 
concentrated and ammoniacal in odor. Under these circumstances 
one of three drugs may be used with advantage, namely, hexamethyl- 
enamine (urotropin or uritone) in the dose of 4 grains (0.25) in half 
a glass of water three times a day; or benzoate of ammonium, given 
in the same quantity in capsule after meals. Both of these drugs 
acidify the urine and render it antiseptic, and for obvious reasons 
are harmful if the urine is already acid. 

Sometimes these cases are dependent not so much upon vesical 
irritability as upon weakness of the spinal centres governing the 
bladder. If this be the case, the urine should first be rendered mild, 
and then remedies should be directed to the improvement of these 
parts. The following pill or the succeeding solution should be admin- 
istered : 

1$ — Arseni trioxid . gr. J (0.02). 

Extract, nucis vomicae gr. ij (0.12). — M. 

Ft. in pil No. xx. 

S. — One three times daily after meals for a child of eight or ten years. 



Or, 



1^ — Liquor potassii arsenitis Til xxiv (1.5). 

Tinct. nucis vomicae TTL xxiv (1.5). 

Aquae dest q. s. ad f giij (90.0). — M. 

-Teaspoonful (4.0) three times daily after meals for a child of eight or ten 



This mixture is so bitter as to be disagreeable, and Fowler's solution 
may often be used alone in the dose of \ to 1 minim (0.025-0.05), and 
at the same time strychnine in gelatin- or sugar-coated pill or granule 
may be given. 



708 DISEASES. 

It must be remembered that this last treatment is only to be employed 
in chronic cases devoid of all irritation and dependent upon atony. It 
will not do good if the urine is not previously made clear. 

Nothing can be more unfortunate in the treatment of these cases 
than punishment by severe scolding or whipping the child, as it never 
does good, and, the fault being beyond the child's control, the unjust 
punishment makes him sullen, or through nervousness, augmented 
by such treatment, his trouble becomes worse. In some cases it may 
be necessary, in order to cure the habit, to let the child drink diuretic 
waters for years. The patient should always be taken from bed when 
the parents retire for the night and made to evacuate the bladder. 

For the incontinence of adult females or males due to atony of the 
vesical sphincter, and which occurs on laughing or sudden movement, 
nothing compares, from a curative point of view, to drop doses of 
tincture of cantharides three or four times a day, the urine being kept 
flowing freely from the kidneys by means of alkaline diuretics. Atten- 
tion to the reaction of the urine in these cases is also of value. If it 
is acid, alkalies must be given; and if alkaline, urotropin or uritone is 
indicated. 

The treatment of the fourth form of incontinence of urine comes 
into the province of surgery. The bladder must be relieved by the 
catheter if the trouble be from retention with distention. If the dis- 
order is due to paralysis, nothing can be done except to carry out those 
general measures valuable in such cases — to maintain the urine in as 
normal a state as possible by urinary antiseptics, to catheterize fre- 
quently with an aseptic catheter, and to wash out the bladder every 
few days or hours, as the case may be, with some weak antiseptic 
fluid, such as the 1 : 10,000 solution of bichloride of mercury, or 1 : 200 
of carbolic acid, or 1 : 100 of boric acid. 



INDIGESTION (GASTRIC AND INTESTINAL). 

Under the heading "Biliousness" the writer has described many of 
the conditions arising out of indigestion, and, this being the case, 
the consideration of that state known as dyspepsia or indigestion will 
only receive attention at this point in so far as its cure is concerned, 
without the relief of the symptoms produced. 

Lack of gastric digestion depends for its existence upon a great 
number of causes, and is always a symptom, not a disease. It occurs 
during the course of short or prolonged fevers from atony of the gastric 
walls and glands, from lack of secretion of the proper character, from 
hypersecretion of mucus by the mucous glands, or as the result of any 
one or all of these conditions, and, lastly, because the food is unsuitable 
to the case, or is of a kind difficult of assimilation, or is readily split up 
into effete products by fermentation, and these in turn, being absorbed, 
produce toxic symptoms. Sometimes it is due to organic changes in 
the abdominal viscera, as carcinoma or ulcer, and sometimes to acute 



INDIGESTION {GASTRIC AND INTESTINAL). 709 

or chronic gastritis. In each of these states the treatment is, of course, 
different, because widely separated causative factors must be relieved. 

The indigestion attendant upon the course of fevers can nearly 
always be avoided by a proper diet and the use of predigested food, 
such as pancreatized beef-tea, milk, or broths. The necessity of this 
artificial digestion is the more readily recognized when we recall the 
investigations of Hoppe-Seyler upon the quality of the gastric juice 
of a patient suffering from typhus fever, for he found that no hydro- 
chloric acid was present. Uffelmann has also found in a similar study 
that the peptone-forming secretion of the stomach ceases entirely 
during fever. 

Where indigestion results from the presence of gastric catarrh the 
remedies applicable to such a state must be resorted to. (See Gastric 
Catarrh.) 

The studies made within recent years upon the chemical conditions 
of the gastric contents have changed the methods of treatment from 
being empirical to being rational, for it is now known that disorders of 
digestion depend on deficient or excessive acidity of the gastric juice, 
deficient formation of pepsin, deficient motility of the gastric walls, 
gastroptosis and enteroptosis, and other less important causes. Before 
carrying out any line of treatment the physician must therefore decide, 
if possible, as to the underlying cause of the dyspepsia present in 
each case, and his decision may be based on well-described subjective 
symptoms by the patient, or upon this description aided, or it may be 
replaced, by examination of the stomach-contents after a "test- 
meal." 

In those cases in which the dyspeptic symptoms result from imper- 
fect mastication and insalivation of food it is evident that careful rules 
about eating are to be given the patient, with the additional advice, 
which is equally good in all cases, that exact meal-hours shall be 
adhered to, since irregularity in meal-hours results in imperfect digestion 
as commonly as irregularity of habit in regard to defecation results in 
constipation. If the dyspeptic symptoms are due to deficient secretion 
of gastric juice, particularly if it is found that hydrochloric acid is the 
chief deficient element, one of two plans presents itself for employ- 
ment. In many cases it will be found that the administration of 
small doses of bicarbonate of sodium, 5 to 10 grains (0.3-0.60), before 
each meal will cause a free secretion of gastric juice, particularly if it 
be given simultaneously with bitter substances which act as stimu- 
lants to the gastric mucosa. These facts are not based solely on the 
apparent improvement in the patient, but also upon careful chemical 
studies of the acidity of the gastric juice by means of the stomach- 
tube. In mild cases the taking of a glass of imported Celestin Vichy 
water before each meal serves to provide sufficient sodium to produce 
good effects. The bitter substances which it is best to employ in 
cases of deficient acidity of the gastric juice are among the simple 
bitters, such drugs as quassia, cascarilla, calumba, and gentian. Among 



710 DISEASES. 

the peculiar bitters we have nux vomica, quinine, rhubarb, and con- 
durango. These may be employed in the following form: 

1$ — Sodii bicarbonatis 3j (4.0). 

Tinct. nucis vomicae f 3j vel fgij (4.0 vel 8.0). 

Tinct. gentian, comp. . . q. s. ad f §iij (90.0). — M. 
S. — Teaspoonful to a dessertspoonful (4.0-8.0) before meals. 

When there is deficient gastric secretion through atrophy of the gastric 
tubules or carcinoma of the stomach, the use of hydrochloric acid is 
the better plan. Under these circumstances the following prescription 
may be ordered: 

I$— Acid, hydrochloric, dil f 5j j vel f5iv (4.0-15.0). 

Fluidext. condurango f §j (30.0). 

Tinct. cardamomi comp. . q. s. ad f 5iij (90.0). — M. 
S. — Dessertspoonful (8.0) with or after each meal in water 

The symptoms manifested by persons needing the treatment just 
named are variable, but generally of sufficient constancy in type to be 
fairly pathognomonic. There are generally loss of appetite, some 
impairment in general health and nutrition, and marked difficulty in 
digesting food, particularly if it be in solid form. Complaint is usually 
made of a sensation of weight after eating, without any real pain, but 
indigestion is not complete, owing to the food being finally disposed 
of in the duodenum. Often because of the delay in gastric digestion 
there is some belching of gas due to fermentation of the food in the 
presence of warmth and moisture, and without the antiseptic influ- 
ence of the gastric juice. If any food is brought up with the belching, 
it is unaltered or changed only by fermentation. Examination of 
the stomach-contents for hydrochloric acid by the phloroglucin-vanillin 
test will speedily confirm the diagnosis of absence of hydrochloric acid, 
and this confirmation should be sought for in every case. 

In the cases of gastric indigestion depending upon hypersecretion 
of the acid of the juice a line of treatment quite at variance with that 
just discussed must be instituted. This may be divided into the 
direct and indirect forms, including the remedies which distinctly 
decrease gastric secretion and those which antagonize or overcome its 
acidity after it is poured out from the glands. In the first class we 
find both general and local nervous and glandular sedatives, and in 
the second alkaline drugs. Of the first class we have hyoscyamus, 
belladonna, and opium from the vegetable kingdom, and the bromides, 
bismuth, and nitrate of silver from the mineral. Of the second class 
we have massive doses of sodium bicarbonate taken during or after 
meals, ammonia, generally in the form of the aromatic spirit, and 
magnesia and chalk. 

As many, if not all, of the cases suffering from hyperacidity are of a 
nervous temperament, these drugs do good by quieting reflex activity 
throughout the nervous system connected with digestion, and by a 
local action on peripheral nerves, or on the glands themselves, diminish 



INDIGESTION {GASTRIC AND INTESTINAL). 7H 

secretion. Of particular value for this purpose is hyoscyamus, which 
very markedly decreases gastric secretion directly and indirectly, and 
at the same time relieves gastric pain by its local sedative influence. 

Taking gastric ulcer as a typical instance of a condition of excessive 
secretion of hydrochloric acid, it will be found that the following pill, 
combined with an absolute milk diet or, for the first few days, allowing 
only rectal alimentation by peptonized food, will be most useful : 

R — Argenti nitratis gr. v (0.3). 

Extract, hyoscyami gr. x (0.60). — M. 

Ft. in pil. No. xx. 

S. — One pill one hour before taking food. 

Sometimes in place of this pill it is wise, particularly if no ulcer 
exists, to give 10 to 20 grains (0.60-1.3) of bromide of strontium one 
hour before meals, and in any case where this fails to control excessive 
secretion of acid full doses of sodium bicarbonate may be given, 20 or 
30 grains (1.3 or 2.0) or more, after each meal. The following formula 
may be used: 

R — Magnesise (hydrated) Siijss (14.0). 

Bismuthi subnitrat 5ijss (10.5). 

Cretse preparatse 3hjss (14.0). 

Sodii bicarbonat. ........ 5iijss (14 0). — M. 

Ft. in chart. No. xx. 

S. — One powder three hours after meals. 

When the bromides are given, it is best to give them in solution. If 
the stomach is very irritable and there is a tendency to vomiting, a 
powder composed as follows is often useful: 

R — Phenolis (cryst.) gr. xx (1.3). 

Bismuthi subnitrat gr. cc (13.2). — M. 

Ft. in chart. No. xx. 

S. — One t. i. d. with or before food. 

The symptoms manifested by the patients requiring this treatment 
are as follows: There is often a constant sense of gnawing or hollow- 
ness in the stomach, which is sometimes temporarily allayed by the 
taking of food. The patient is, as a rule, of a nervous temperament 
and often in a condition of nervous depression due to some exhausting 
cause. Tenderness and even pain in the epigastrium may be pro- 
duced by superficial or deep palpation, or the patient may complain 
that the pressure of her clothes is distressing. If ulcer of the stomach 
is present, all the characteristic symptoms of that lesion may be found. 
When belching occurs, there is often vomiting of sour masses or acid 
eructations or heartburn. Gastralgia more or less severe may also 
occur. Sometimes such patients are neurasthenic and need a rest- 
cure. 

In cases where testing the stomach-contents shows that the excessive 
acidity is not due to hydrochloric acid, but to the acids of fermentation, 
the use of the sedative drugs named is of no avail for obvious rea- 



712 DISEASES. 

sons, and in their place sodium bicarbonate should be employed as a 
palliative, and antiseptic or antifermentative drugs, such as thymol, 
beta-naphtol, creosote, chloral, and sodium hyposulphite, as direct 
remedial agents. Lavage of the stomach should also be resorted to. 
In still other cases a mixture containing chloral and hyposulphite 
of sodium is useful because of its antiseptic influence. (See Chloral.) 
Often these cases are relieved if all fats, and butter in particular, 
are excluded from their diet-list. 

If much gas is developed and a sensation of weight in the stomach 
is felt after eating, so that the patient feels as if the food lay undigested 
in that organ, the following prescription may be used, but is contra- 
indicated if the stomach is tender on deep palpation, or, in other 
words, if acute irritation or inflammation of the stomach is present. 
It is useful in atonic states of the stomach, and it is surprising how 
much relief may be afforded by the use in such cases of these pre- 
scriptions : 

R — Oleoresin. capsici . . ... . . TTLij (0.1). 

Pepsin, vel pancreatin. . . . . . gr. xx (1.30). 

Carbo ligni gr. xl (2.60). 

Creosoti Tu_x (0.60).— M. 

Ft. in pil. No. xx. 
S. — One after eating. 

Another useful formula is: 

1^ — Pulv. capsici . gr. x (0.60). 

Extract, nucis vomicae gr. v (0.3). 

Taka diastase gr. xl (2.60).— M> 

Pone in capsul. No. xx. 
S. — One with meals. 

Intestinal indigestion depends upon almost the same causes as does 
gastric dyspepsia, and is to be treated in much the same manner, 
chiefly by a careful study and regulation of the patient's diet, and by 
the use of a number of remedies calculated to aid to some extent the 
normal juices by some digestive ferment. These ferments should be 
given with the meals, or the food be " predigested " before it is taken. 

The pancreatin should be given in full dose (5 to 10 grains [0.3- 
0.60]), with bicarbonate of sodium, and alkaline mineral waters used 
if the urine is concentrated and acid. (See Biliousness.) 

Sometimes where intestinal indigestion is present great flatulence 
comes on, and is an annoying symptom. Very commonly in these 
cases it will be found that the patients think they have heart disease 
because of the pain they suffer under the prsecordium. This pain is 
due to the accumulation of flatus in the small intestine, or more com- 
monly to its pressing upward at the angle where the transverse colon 
turns to go down to form the descending colon and sigmoid flexure. 
Under these circumstances the prescriptions named above will be 
found of service, or the following may be used: 



INFLUENZA. 713 

^— Acid, nitric, dil fgijvel 3 iij (8.0-12.0). 

Tinct. cardamom, comp f§vj (180.0). — M. 

S. — Dessertspoonful (8.0) in water four times a day. 

In some persons flatulence of the large bowel is met with, and is 
often associated with atony of the muscular coats of the gut. Under 
these circumstances the following prescriptions will be found of service : 

I$— Asafcetidae gr. xl (2.6). 

Extract, nucis vomicae . . . . . gr. iv (0.25). 

Extract, physostigmatis gr. iij (0.20). 

Oleoresin. capsici TTlx (0.60). — M. 

Ft. in pil. No. xx. 

S. — One pill three times a day, two hours after meals. 



Or, 



Py— Tinct. belladonnas f 3 iij (12.0). 

Tinct. physostigmatis f ^iss (6.0) 

Spt. camphorae . . . . q. s. ad f ^5 iij (90.0). — M. 
S. — Teaspoonful (4.0) two hours after meals or whenever needed. 



Abdominal massage is a valuable aid in treating this class of cases. 
Sometimes it can be well done by directing the patient to roll slowly 
and gently a three-pound cannon-ball over the course of the colon, to 
urge on the intestinal contents and cause secretion. In other instances 
the application of a roller electrode with the rapidly interrupted cur- 
rent from a faradic apparatus is useful. 

Where intestinal indigestion results in lientery the treatment 
becomes entirely changed, except in regard to the use of a predigested 
milk diet, and efforts must be made to increase the secretion of the 
glands of the intestinal wall. Often minute doses of mercury bichlo- 
ride or podophyllin may do this, -g 1 ^- to fa grain (0.001-0.0015) of the 
first or second, respectively. More commonly, however, the mixture 
of nitric acid, given above, will be the proper treatment or perhaps 
the following if the liver is found to be torpid: 

1^— Acid, nitrohydrochlor. (not dil.) . . f 5ss vel f 3j (2.0-4.0). 
Tinct. gentianae comp. . . q. s. ad fgvj (180.0). — M. 
S. — Dessertspoonful (8.0) every four hours or after meals, in water. 

Chloroform spirit is often valuable in some of these cases in the 
dose of 30 minims (2.0). (See Chloroform.) 



INFLUENZA. 

The disease known as influenza affects individuals so differently, 
and presents so many symptoms associated with functional disorder 
of various organs in the body, that it is almost impossible to do 
more than consider the remedies which are to be employed in the 
treatment of the more frequent or more immediate manifestations or 
complications. Of far greater importance than the employment of 
drugs must be regarded continuous rest in bed, and stimulants are in 
many cases absolutely essential. 



714 DISEASES. 

In those cases in which the disease is ushered in by a severe chill, 
accompanied by violent pains in the back, if the patient is seen early 
enough it may be necessary to employ remedies for the relief of the 
rigor, with the double purpose of improving the patient's general con- 
dition and preventing internal congestion of vital organs. In the 
majority of instances, however, the patient is not seen during this 
period of the disease, but during the febrile stage, which succeeds 
that just mentioned. Under these circumstances the author does not 
believe that it is well for the physician to resort to any of the remedies 
which have been so largely used during the last few years, and which 
are known as the "antipyretics" or the derivatives of coal-tar. Although 
originally introduced for the purpose of reducing febrile tempera- 
tures, practical experience has taught that their value is very limited 
under these circumstances, and the author almost never gives antipyrin, 
phenacetin, or acetanilid with the object of reducing fever. Although 
he does not believe that these remedies are to be used for the reduction 
of temperature, he has certainly seen very marked relief follow their 
employment with the object of subduing the severe pain which occurs 
in the back, limbs, or head. Small doses are usually sufficient at least 
to reduce the suffering, if not to remove it entirely, but, as cardiac 
complications are by no means unusual, large doses are contraindi- 
cated in most persons. The author prefers to allow the patient to 
suffer from a moderate degree of pain rather than from the dangers 
incident to the administration of doses large enough to relieve it 
entirely, because in his experience these doses have to be very large 
if they are to be entirely competent as analgesics in influenza. 

If any of the coal-tar products are used either for the relief of fever 
or of pain, phenacetin and acetanilid should be chosen. Experi- 
ments made in America and in Germany on animals have proved 
that phenacetin is far less toxic in its relations to the heart than is 
antipyrin or acetanilid, and while it has in a number of instances 
seemed more apt to produce cyanosis in man than other drugs, this 
cyanosis rarely, if ever, has been associated with any other dangerous 
symptoms. Indeed, it is quite extraordinary the amount of cyanosis 
which phenacetin may produce without the respiration becoming 
greatly disordered, very much less cyanosis when caused by acetanilid 
or antipyrin being accompanied by much more alarming symptoms. 
A very favorite combination with practitioners who have had a large 
experience is one of phenyl salicylate and phenacetin. The action of 
the phenacetin in relieving the pain and in reducing the fever seems to 
point to it as a rational remedy, but the exact influence of phenyl sali- 
cylate under these circumstances is not so clear. Composed, as it is, 
of 60 per cent, of salicylic acid and 40 per cent, of phenol, it seems 
to possess a therapeutical power different from that possessed by 
either of these two constituents alone, for neither phenol nor salicylic 
acid has much power in the relief of pain when used alone, unless, as 
in the case of phenol, it is applied directly to the part affected. Per- 



INFLUENZA. 715 

haps the condition of pain in the lumbar and other muscles during 
the attack of influenza is in some unknown way associated with the 
condition which has been called "rheumatism," and in which salicylic 
acid does good in an unknown manner. Salicylic acid alone might 
be equally useful if it were dissolved in the intestine and did not irritate 
the stomach. 

On seeing a case of influenza during the first few hours of the attack 
the author resorts to those remedies which have been in use by the 
profession for many years, and, so far as he can learn, it is the custom 
of other members of the profession to give a mixture composed of 
spirit of nitrous ether and a solution of citrate of potassium in pref- 
erence to any other medicine at this time. This mixture possesses 
the advantage of increasing the action of the skin and kidneys, and 
of reducing the temperature, of quieting the circulation, and of being 
readily taken by the patient without danger of disordering the stomach 
at this time or later, which is important, as this organ is apt to become 
irritable. As a general rule, citrate of potassium is given in too small 
doses, and, unless there are reasons to the contrary, it should be 
given in the dose of 10 to 15 grains (0.60-1.0) three times a day to 
an adult. 

If the fever becomes excessive, so that there is danger of the patient 
suffering from a true hyperpyrexia, it is better to resort to cool sponging 
instead of the antipyretics just spoken of. It is a very important 
portion of this treatment to use frictions designed to bring the heated 
blood to the surface. (See Cold and Fever.) 

Hyperpyrexia in influenza does not seem to possess the same dangers 
that it does in the course of some other diseases. In the first place, as 
a general rule, the course of hyperpyrexia is very brief, and, although it 
may leave the patient weak and exhausted, the duration of the febrile 
portion of the malady does not extend beyond a few days. Clinical 
experience and physiological study have proved that it is not the tem- 
perature of 105° or 106° F. w T hich is distinctly dangerous, but the 
continuation of this temperature for many hours which is harmful. 
Similarly, a patient ill from typhoid fever, having a temperature of 
103° for many days, is injured very much more than is a patient w T ho 
is suffering from pneumonia, and who may have for forty-eight hours a 
temperature of 104.5° or 105° F. For these reasons a temperature 
of 104.5° or 105° F. is not particularly alarming in the condition w T hich 
we are considering, unless there are symptoms pointing to the fact 
that the patient is being injured by an excessive temperature, as may 
be indicated by somnolence and an exceedingly dry skin as well as 
cerebral symptoms. The point to be strongly emphasized is that the 
mere existence of high temperature is not to be regarded as a condition 
to be overcome by the use of drugs. 

It seems to be the general consensus of opinion, both in America 
and in England, that any measures of a depleting character are dis- 
tinctly harmful in influenza, even at its earliest stages, and we would 



716 DISEASES. 

naturally expect that this would be the conclusion arrived at by phy- 
sicians who treat their patients rationally. Although influenza is a 
short-lived disease, there is probably no malady in which the patient 
goes so quickly into a condition of profound depression, or even 
exhaustion, as in this one, The abstraction of blood from a vein or 
by the use of wet cups for the relief of pulmonary congestion should 
not be resorted to, as it will increase the exhaustion. Before the sys- 
tem has a chance to recover from the onset of the attack it will be still 
further depressed by the therapeutic measures of the physician if he is 
unwise enough to bleed. 

As the case of influenza progresses a condition of marked depression, 
or even collapse, very frequently develops. The expression of anxiety 
on the patient's face is, to a physician who is accustomed to see it in 
other diseases, a most alarming symptom, and it is not until one has 
seen it repeatedly in influenza that he is able to give it its exact value. 
Associated with this condition, the skin is frequently covered with a 
profuse perspiration, and the pulse is apt to be very rapid, running, 
feeble, and easily compressed. At first glance the old saying, that 
"we treat the symptoms as they arise," would seem to cover to a 
very large extent the indications which are present at this period; yet 
the author's experience, which may differ from that of some of his 
readers, is that the cardiac stimulant which we are most frequently 
accustomed to use — namely, digitalis — does not seem to take hold of 
the circulatory apparatus and to act upon it in the manner which is 
desired. It may be that the pressing symptoms make us more 
anxious and impatient as to the use of any medicament, and that we 
do not have the patience to wait and allow such a slowly acting 
remedy as digitalis to take effect. Be this as it may, the author regards 
strychnine as infinitely preferable to foxglove when these symptoms 
appear; and he has been able to prevent their appearance, or at any 
rate to modify them to a very great extent, by using strychnine in full 
doses from the first portion of the stage of depression. As a general 
rule, strychnine is given in very much smaller doses than safety requires, 
and in many instances it fails to act because the doses are too 
small to combat the profound condition of exhaustion which is 
present. In an adult there is no reason why ^o" grain (0.003) may 
not be given three or four times in twenty-four hours, and in some 
cases it may be given every four hours without producing any of the 
symptoms of an overdose. Divided doses are better than a few very 
large ones. 

In the employment of strychnine in influenza, the author knows of 
no better illustration of the fact that in some conditions drugs should 
be given for effect rather than in customary dose, and the physician 
who is timorous in the presence of this frequent complication, de- 
pression, certainly does not lessen the patient's danger. As with all 
powerful medicaments, the action of the drug should be carefully 
watched, and at the first manifestations of muscular twitching or stiff- 



INFLUENZA. 717 

ness at the back of the neck its administration should be cut down 
or discontinued. In many instances where the collapse comes on 
suddenly the strychnine should be administered hypodermically and 
followed by full doses by the mouth, in order to keep up the full effect 
upon the nervous and circulatory systems. In some cases it will be 
found that the bloodvessels seem to be so atonic that the strych- 
nine is unable to produce a sufficient vascular effect to bring the 
patient out of his difficulties, and under these circumstances very 
good results follow the combination of belladonna with strychnine, 
the belladonna being a useful vasomotor stimulant under such circum- 
stances. It also should be given in full doses for effect. As the acute 
stage of depression passes off the belladonna should be stopped and 
the strychnine continued alone through convalescence. It is proper 
to point out, however, that strychnine is not suitable for the purpose 
of producing constant stimulation. It is a whip to the nervous system, 
and if used in too large a dose for too long a time the overwhipped 
system fags out. Under these circumstances it may cause an active 
delirium. 

Alcohol has not seemed to be of much value during the active period 
of the disease. In milk-punches and egg-nog it is, of course, useful 
during convalescence. 

When delirium comes on, it does not seem to be a symptom of very 
serious character either for immediate results or in influencing the 
prognosis as to the ultimate recovery of the case, and in cases of pneu- 
monia complicating la grippe, in which delirium is the prominent 
symptom, it is not to be regarded in the same light as similar mani- 
festations complicating ordinary pneumonia or other diseases. The 
delirium may be either talkative or muttering, but does not in the 
majority of cases require treatment, passing away with the fever and 
rarely extending into the stage of exhaustion. 

For the irritative cough steam inhalations, laden in the first stage 
with benzoin or other innocuous and sedative substances, seem par- 
ticularly useful. For the bronchitis which is often present it is gen- 
erally sufficient to administer the ordinary mixtures, containing ipecac 
and potassium citrate, in the earliest stages, and to follow them by 
chloride of ammonium and cubebs in the later stages. The author 
does not think that the compound liquorice mixture containing anti- 
mony should be given in the second stage of influenza. A complication 
too apt to occur at this time is oedema of the lung or a widespread 
bronchitis, with a profuse exudation which bids fair to drown the 
patient in his own secretions. Antimony is not only depressing to 
the circulatory and respiratory systems, but also aids verv materially 
in causing the peculiar excess of secretion which has just been spoken 
of. Atropine is in reality the drug of choice. 

It may be necessary to use bromides if the cough is excessive, or 
to replace them by codeine or very small doses of morphine. In many 
cases still better results will be obtained by a good preparation of 



718 DISEASES. 

cannabis indica, which may be pushed until it relieves the cough with- 
out in any way endangering the patient's life — a safety which cannot 
be obtained by the employment of any other of the drugs named. 

If sleeplessness is so pressing a symptom as to require attention, the 
bromides may be given, but it will be generally found that the insomnia 
comes after the attack rather than during it, or in any event it will not 
require attention until the patient is convalescent. Under these cir- 
cumstances chloral or chloralamide, or even sulphonal, may be admin- 
istered, care being taken, of course, in the case of chloral that the 
cardiac apparatus is in good condition, and in the case of sul- 
phonal that it is administered in a powdered form or dissolved in 
hot water and given four or five hours before the time at which sleep 
is desired. 

For the vertigo and dizziness which are sometimes bitterly com- 
plained of by the patient either during or after the attack, moderate 
doses of bromide of sodium with ergot or cannabis indica have seemed 
particularly valuable, probably because they exercise some effect 
upon the bloodvessels of the brain or its membranes or perhaps 
upon the bloodvessels of the ear. Certain it is that in those cases 
of tinnitus not associated with organic change in the aural canals 
bromides and ergot do more toward relieving them than any other 
medication. 

In the constipation which is sometimes present in the early stages 
of influenza it is generally advisable to administer either castor oil 
or in other cases \ ounce (16.0) of the sulphate of magnesium, or for 
more fastidious patients the citrate of magnesium. A full purgative 
effect of any of these salines seems to lessen the fever when the bowels 
are unloaded. Care should be taken that the dose of the purgative 
is not excessively large, as it will weaken the patient. For the con- 
stipation following the attack probably no drug is so efficient as 
cascara sagrada, combined perhaps with aloin. (See Constipation.) 
If diarrhoea supplants the constipation, the ordinary astringents, 
such as aromatic sulphuric acid or hematoxylin, will be found suffi- 
ciently active. (See Diarrhoea.) 

INSOMNIA. 

Insomnia is a condition complicating many diseases, and arises 
from such a host of causes that the physician may not be able to dis- 
cover them for some days after the patient is first seen. As a general 
rule, a patient consulting a physician with this symptom expects a 
prescription to be given at once and the cause of the insomnia found 
out afterward. Under these circumstances the physician may employ 
several drugs according to the information that he has concerning 
the patient's state. 

One of the most common remedies is chloral given in the following 
manner: 



INSOMNIA. 719 

R— Chlorali hydrati 5iij (12.0). 

Syrupi f oiv (16.0). 

A quae cinnamomi . . . . q. s. ad i'oiij (90.0). — M. 
S — Dessertspoonful (8.0) at night. 
Or, 

Bf. — Butyl chloral hydrat 5j (4.0). 

Ft. in pil. No. xii. 

S. — One, two, or three pills at night, as needed. 

Where, for any reason, as the presence of a weak heart, chloral is 
contraindicated, resort may be had to the bromide of potassium or 
sodium, and if the patient is a woman these drugs should always be 
accompanied by a small dose of arsenic, generally in the form of 
Fowler's solution, 1 to 3 minims (0.05-0.20) three times a day in 
order to avoid the possibility of the production of acne. The fol- 
lowing prescription is useful: 

I$— Potassii bromid £ ij vel ^ss (8.0-16.0). 

Liq. potassii arsenit t' t ^ss (2.0). 

Aquae cinnamomi . . . q. s. ad f^vj (180.0). — M. 
S. — One or two dessertspoonfuls (8.0-15.0) at night. 

In many cases larger amounts of the bromide will be needed. 

Where the sleeplessness is due to pain, chloral is of little value and 
bromides are worthless. Under these circumstances by resorting to 
what is known as the "crossed action of drugs," we can often obtain 
a very good effect. Thus morphine and chloral both act on the brain 
to produce sleep, or, in other words, their action is here crossed, for 
one relieves pain and the other does not; one kills by failure of the 
heart in overdose, the other by respiratory failure; as a consequence 
large doses of neither can be given alone. The following is therefore 
a useful combination, either where one drug fails or when danger- 
ously large doses of either alone have to be used to obtain the desired 
result. 

ty — Morphinae sulphatis . . . . . gr. ij vel iv (0.12-0.25). 

Chlorali hydrati ...... 3ij (8.0). 

Syrupi fgij (60.0). 

Aquas q. s. ad fgiv (120.0) —M. 

S. — Dessertspoonful (8.0) at night. 

In cases where insomnia is due to mania hyoscine is said to be very 
useful, given in the dose of y^- to -^ grain (0.0007) by the mouth or 
yy-Q- or y-jj-Q- grain (0.0006) by the hypodermic needle. Owing to its 
tastelessness the powder may be put on the tongue, and it is best to 
order a little sugar of milk or white sugar (1 grain) to be added to each 
dose of hyoscine, in order to give it bulk. 

Where insomnia follows mental effort, avoidance of all cerebral 
activity should be insisted upon during the evening, and if the feet are 
cold on going to bed sleep should be induced by relieving the cerebral 
congestion by a hot foot-bath or the use of a hot-water bag at the feet 
while cold is applied to the head. In other instances a general hot 
bath, during which an ice-bag is applied to the head, will produce 



720 DISEASES. 

sleep when drugs fail ; and it is to be remembered that in the insomnia 
of convalescence and neurasthenia hydrotherapeutic measures are to 
be used to the exclusion of drugs (see Cold and Heat), for the former 
cure the condition, while the latter only palliate, and may produce a 
drug-habit. 

Not infrequently patients convalescing from prolonged illness suffer 
from drowsiness during the day and wakefulness at night because the 
circulation is feeble and fails to supply the brain with blood while the 
body is erect, but does so very well when recumbent. Hydrotherapy 
to improve vascular tone and the use of a pill of nux vomica and 
arsenic, or nux vomica and phosphorus, is useful in these cases. 

During the last few years a large number of remedies have been 
introduced as hypnotics, such as chloretone, somnal, paraldehyde, 
chloralamide, sulphonal, trional, amylene hydrate, hypnal, and others. 
Of these the best, from every point of view, are sulphonal, trional, and 
chloretone. The dose of sulphonal and trional is 10 to 20 grains 
(0.60-1.3) in powder, but, as they are large in bulk and not easily 
swallowed, they should be used in a prescription made up as follows: 

1$ — Sulphonal. (sulphonmethani) . . . gr. xxx (2.0). 

Sympi . . . . ■ fgij (8.0). 

Mucilaginis acacise f 3 i j (8.0). 

Aquse destillat q. s. ad f oj (30.0).— M. 

S. — From half to all of this at one dose, as may be needed. 

In other instances sulphonal may be dissolved in very hot water or 
milk, and the solution swallowed before it cools sufficiently to permit 
precipitation. 

In ordinary nervous insomnia or that due to heart disease chloretone 
often acts very efficaciously in the dose of 10 to 20 grains (0.60-1.3) 
in tablets or capsules of 3 to 5 grains (0.20-0.30) each. 

Chloralamide (Chloralformamide.XJ.S.'Y.) maybe used in the dose 
of 15 to 60 grains (1.0-4.0), dissolved in wine or given in capsule. 
Paraldehyde is given in the dose of 20 to 60 minims (1.3-4.0). As it 
is disagreeable in odor and taste, it must be given in capsule, and it 
is very apt to disorder the stomach. 

Somnal is used in the dose of 10 to 40 minims (0.60-2.60) with 
liquorice and water, and possesses considerable power. 

In the treatment of insomnia it should be remembered that if pos- 
sible those drugs should be used which will quiet the part of the brain 
which is most active. Thus if the patient is restless, bromides and 
chloral should be used as motor depressants. If sensation is acute, 
bromides and the hot pack may be used as sensory quietants. 

In some cases horseback exercise taken late in the afternoon does 
good, particularly if the patient follows a sedentary life. Many per- 
sons who are usually sleepless will obtain a refreshing slumber by 
taking a very light and easily digested meal just before retiring for 
the night or by eating a cracker or drinking a glass of milk when 
they awake during the night. 



INTERMITTENT FEVER. 721 

In some instances sleeplessness arises from acidity of the stomach, 
and is put aside by the use of bicarbonate of sodium. 

INTERMITTENT FEVER. 

It having been proved that malarial fever is practically always 
the result of the bite of a mosquito, Anopheles quadrimaculatus, 
the disease is to be prevented by destroying mosquito-breeding pools 
and by protecting the skin. It is also important to prevent mosquitoes 
from biting a patient with malaria, as by this means the infection is 
spread. Such patients should sleep under a netting. 

In all forms of intermittent fever, whether the attacks are quotidian, 
tertian, or quartan, the best remedy for their prevention is quinine, 
which should under these circumstances be given about two or three 
hours before the attack is expected, so as to be absorbed and be physio- 
logically active when the paroxysm is due. This precaution is often 
overlooked, and the dose ordered at the time of the expected attack, 
with failure as a result. Not only should sufficient time elapse for 
absorption, but the fact should be remembered that the chill often 
begins an hour earlier each day, and will be in full sway before the 
quinine can stop it if the drug be not administered at the proper time. 

There are two methods of giving quinine in malaria. In one it is 
given just before an expected paroxysm, to prevent it by destroying 
the parasite at the time of maturity. In the other plan the drug is 
administered in the sweating stage, not because it will have any valu- 
able influence on that particular paroxysm — which is nearly over — but 
in order that it may destroy the young spores which are floating free 
in the blood-stream and about to attack corpuscles, in which they will 
mature. Undoubtedly if the quinine is given at the proper time before 
an attack it tends not only to prevent the oncoming paroxysm, but also 
future ones by its influence upon the mature and immature parasites. 
If, therefore, the patient is seen before the attack, he should receive 
quinine to prevent or modify it. If seen after an attack is well advanced, 
he should receive a dose to prevent the next attack by destroying the 
crop of parasites set free in the blood during the paroxysm just passed. 
When the patient is seen during an intermission, the following 
plan of quinine medication is wise: If the infection be due to the 
tertian organism, which causes an attack every forty-eight hours, the 
quinine should be given every alternate day in full dose, as already 
described. If there be a double infection with this organism, so that 
the attacks occur daily, then the full dose must be given daily. If the 
quartan parasite, or that which matures every seventy-two hours, is 
the cause of the attack, then the full dose of quinine should be given 
on the day of the expected attack long enough before to be absorbed, 
and smaller doses between the attacks to maintain a quinine influence. 
If, however, there be a double quartan infection, then the attack 
occurs on two consecutive days with a third day free. Here the quinine 

46 



722 DISEASES. 

is needed on the two severe days and only in small doses on the inter- 
vening day; or if there be a triple quartan infection, it is used every 
day in full amount to antagonize each brood of parasites as they mature. 

Very much smaller doses of the quinine will be needed if the patient 
rests in bed than if he is up and about. 

Experience has proved that quinine never acts as favorably if con- 
stipation is present as when the bowels are lax, and hepatic activity 
seems particularly necessary for its full effect. To obtain the full 
influence of the drug, it should be preceded, by some four or five hours, 
by J to J grain (0.010-0.015) of calomel every fifteen minutes until a 
grain (0.06) is taken, or by a dose of podophyllin amounting to yV to 
i grain (0.006-0.008). If the podophyllin is used, a longer time 
should be allowed, because of the slow action of this purgative, and if 
the patient has been rendered unusually insensitive to purgatives^ 
larger doses of both the remedies named must be used; particularly 
is this true in the South, where 5 to 20 grains (0.3-L3) of calomel are 
often used and really needed. 

The dose of quinine varies with the exigencies of the case which 
in turn generally depend upon the region in which the patient lives or 
has lived. If the patient remains in bed, smaller doses are needed 
than if he remains up and about; 10 to 15 grains (0.60-1.0) in one 
dose are generally sufficient in the eastern and northern States, but 
as much as 20 to 45 (1.3-3.0), or even 60 grains (4.0) may be required 
in the southern and southwestern parts of the United States and else- 
where. When still larger doses are employed, the drug should be 
given partly hypodermically and partly by the rectum in suppository 
or in solution, as well as by the stomach, as this viscus will rarely 
withstand 60 grains (4.0) without irritation. (For the best salts of 
quinine for hypodermic use, see article on Cinchona.) If the stomach 
is irritable, resort to these means of entrance into the body are abso- 
lutely necessary and must be wholly relied on. 

Having considered the prophylaxis of a chili, let us turn to the 
treatment of the attack itself. It must be remembered that the greater 
part of the harmful effect of the malarial poison is exerted at this 
time by the internal congestions and engorgement of the abdominal 
and thoracic organs. The physician should therefore try to prevent 
as far as possible, too great a rigor; and if stasis results from the chill 
overcome it, not by depletants, unless the case is very sthenic, but by 
stimulants, such as strychnine or digitalis, which will drive out the 
blood from the congested area. 

If a full meal has just been eaten, the stomach should be emptied 
by an emetic dose of ipecac, 2 drachms (8.0) of the powdered drug to 
an adult, or by 20 grains (1.3) of sulphate of zinc. It is almost useless 
to give quinine at this time, as absorption from the stomach and sub- 
cutaneous tissues is almost entirely absent. Alcoholic stimulants 
are not to be employed, as clinical experience seems to indicate that 
they act unfavorably. 



IRITIS. 723 

If the chill is severe enough to endanger the patient's life, measures 
must be used to control it. Chloroform may be inhaled, and immedi- 
ately preceded by laudanum by the bowel or mouth. If the laudanum 
is given by the mouth, a little ether or chloroform may be added to 
the dose of the opiate. The opium may be used hypodermically in 
the form of morphine in the dose of \ grain (0.01) combined with -g- 1 -^ 
grain (0.001) of atropine. 

In the fevered stage little can be done except to give the patient 
comfort by cool drinks and cool sponging, or, if the fever becomes 
excessive, by the use of ice-cold sponging with active friction. These 
measures have seldom to be used, as the fever is generally too fugitive 
to need such treatment. 

The sweating stage needs no particular treatment unless exhaustion 
is caused by it when stimulants may be cautiously used as needed, 
and large draughts of water at ordinary temperatures swallowed. 

Many measures have been resorted to to abort a malarial attack, 
the chief of which is the use of ether or chloroform anesthetization 
at the time of the expected paroxysm, of nitrite of amyl or of the nitrite 
of potassium or sodium in 10-grain (0.60) dose for the same purpose. 
Where the " chill habit" exists and depends largely upon nervousness, 
it has been broken by misplacing the hands of the clock, and so getting 
the patient past the time for his attacks without his knowledge. 

It should be remembered that the use of quinine in malarial fevers 
is no longer based on empiricism, but upon the fact that the drug 
exerts a peculiarly lethal influence over the cause of the disease, the 
Plasmodium malaria of Marchiafava and Celli, or, as it is sometimes 
called, the malarial germ of Laveran or the hsematozoon of malaria. 

It is worth remembering that methylene blue possesses antimalarial 
proDerties in the dose of 1 to 4 grains (0.06-0.25) . (See Methylene 
Blue.) 

IRITIS. 

Iritis* or inflammation of the iris, as usually encountered is caused 
either by syphilis rheumatism, or gout. It may also be traumatic: 
less frequent causes are gonorrhoea, diabetes, malaria, and tuberculo- 
sis. Metastatic iritis occurs in pyaemia, relapsing fever, etc. The 
most marked symptoms are severe brow pain; fine ciliary injection; 
discoloration of the iris and immobility of the pupil, due to the forma- 
tion of adhesions between the iris and the capsule of the lens. The 
most important local remedy is atropine, to be used every two hours 
according to circumstances. If for any reason this is not tolerated, 
duboisine, scopolamine, or daturine may be substituted. Cocaine 
increases the mydriatic power of atropine. 

Pain may be relieved by leeches to the temple and the use of dry 
heat externally (cotton batting heated over a register will suffice) or 
hot fomentations — water, chamomile infusion, or laurel-water (1: 15). 

In traumatic iritis iced compresses are suitable in the early stages, 



724 DISEASES. 

but not in the later periods and not in any other form of iritis. Great 
care must be taken not to mistake iritis for conjunctivitis on the one 
hand, and glaucoma for iritis on the other; delayed use of atropine 
and the employment of astringents on account of the former error, 
or the instillation of atropine because of the latter, would constitute 
a serious therapeutical blunder. In serous iritis, or that variety in 
which there is a hypersecretion of the aqueous humor, which becomes 
turbid, and a precipitate of dark spots occurs upon the membrane of 
Descemet, atropine must be cautiously instilled, owing to the tendency 
to increased tension. If this occurs, paracentesis of the cornea may 
be needed, and pilocarpine should be given internally if the vitreous 
becomes opaque. 

Instead of the subconjunctival injections of sublimate at one time 
highly recommended, Darien advocates cyanide of mercury (1 : 5000 to 
1 : 1000), a few drops of a 1 per cent, solution of acoin being added to 
mitigate the pain. From 1.0 to 15 minims of the cyanide solution 
may be injected subconjunctivally. Similar injections of physio- 
logical salt solution are equally efficacious, and preferable because 
they cause less pain. 

In true syphilitic iritis mercury should be pushed to the point of 
tolerance, but it is not necessary to salivate the patient. Any form 
of mercury usually employed in secondary syphilis may be used — 
calomel, blue mass, or protiodide of mercury; but the most efficacious 
method is by inunction: this is preferable even to hypodermic medica- 
tion in the opinion of many authors. After the mercurial impression 
has been made and the pupil is well dilated, potassium iodide, either 
alone or in combination with bichloride of mercury, is indicated. 

In plastic iritis, appearing six to eight months after the disappear- 
ance of the secondary symptoms, this latter treatment without the 
previous use of mercury has been recommended. 

Rheumatic iritis calls for salicylic acid v oil of gaultheria, and, later, 
potassium iodide; in the chronic types of the affection Zollicoffer's 
mixture is an excellent remedy. Potassium iodide should be admin- 
istered in gonorrhceal iritis, and relief occasionally follows a pilocar- 
pine sweat. In all forms of iritis the treatment of the constitutional 
disorder which has occasioned the local inflammation is necessary, 
and if the iritis becomes purulent surgical interference is usually 
required. In any variety of iritis the intense pain should be alleviated 
with morphine or other anodyne sufficiently active to secure sleep. 
Hyoscine at night is a valuable remedy. Locally dionin (1 per cent, 
solution) is specially recommended by Darier; it causes a somewhat 
prolonged local anaesthesia. It may be combined with atropine and 
cocaine. During the course of the disease saline laxatives may be 
administered, and after subsidence of the inflammation and cessa- 
tion of the specific treatment a course of iron tonics is an excellent 
routine practice. In chronic iritis, and in some forms of relapsing iritis, 
iridectomy is required in order to reopen the angle of the anterior 



KERATITIS. 725 

chamber which has been closed by inflammatory exudates, and thus 
prevent secondary glaucoma. 

KERATITIS. 

Keratitis is the name applied to the various types of inflammation 
of the cornea. If this inflammation is associated with a breach in 
the continuity of the corneal surface 4 it is termed corneal ulcer, and 
four characteristic symptoms supply the indications for local treat- 
ment: (1) photophobia, or dread of ight; (2) blepharospasm, or spas- 
modic contraction of the orbicularis muscle; (3) congestion of the 
bloodvessels, (4) pain; while any existing dyscrasia or constitutional 
condition upon which the local disease may depend requires general 
medication. 

Interstitial Keratitis. 

Interstitial keratitis is that form of chronic diffuse inflammation 
of the cornea characterized by ciliary congestion and a ground-glass 
appearance of this membrane most common between the ages of five 
and fifteen years, and in the majority of cases the result of inherited 
syphilis. No local measure is sufficient, antisyphilitic treatment 
being of paramount importance. During the height of the ciliary 
congestion warm antiseptic lotions and atropine are indicated, the 
latter especially to prevent the tendency to iritis. Severe pain may be 
alleviated by the use of a leech to the temple if the subject be of suf- 
ficient age to justify the employment of local bleeding. Exactly simi- 
lar forms of keratitis are caused by rhachitis, scrofula, rheumatism, 
tuberculosis, and depressed nutrition. In addition to the local meas- 
ures already described, the appropriate constitutional remedies are 
required, particularly iron, arsenic, cod-iiver oil, and Jhe iodides. 
Suitable dietetic and general hygienic measures are important. 

Various other types of keratitis are described as the result of con- 
stitutional disturbances, such as gout (Hutchinson), malaria (Kipp, 
van Milligen), or any condition of the system associated with great 
exhaustion, such as irregularities in the menstrual function, certain 
forms of pulmonary disorders (true herpes of the cornea, Horner). 
The local management of these cases does not differ from that which 
has been described. The coexisting constitutional disturbances must 
be combated with suitable remedies. 

Phlyctenular Keratitis. 

Phlyctenular keratitis appears in the form of small, blister-like 
bodies, sometimes single, sometimes multiple, frequently situated 
directly at the corneoscleral margin, which become yellow, break 
down, and leave an open ulcer (phlyctenular ulcer), to which runs a 
leash of injected bloodvessels. The disease is common in children, 
often follows in the wake of the exanthemata, and is so frequently 
associated with a strumous diathesis that it was formerly called stru- 



726 DISEASES. 

mous ophthalmia. In the majority of cases there is coexisting nasal 
disease, especially adenoid vegetations, which is responsible for the 
frequent relapses of the disorder, even if it does hot cause it. Con- 
gestion may be* relieved by frequent irrigation with a warm boric-acid 
solution. Pain and irritation call for the use of atropine drops (4 grains 
to the ounce [0.25-30.0JJ, which should be continued until the ulcer is 
covered with regenerated epithelium, when the process of cicatrization 
may be hastened by the insertion daily into the conjunctival sac of a 
small quantity of yellow oxide of mercury salve or dusting it with 
finely powdered calomel, providing the patient is not taking at the 
same time any form of iodine. During the whole treatment the eyes 
should be protected by dark glasses and the subject permitted to go 
out into the open air. All local treatment will prove unsatisfactory 
unless associated with strict hygiene, carefully regulated diet, and con- 
stitutional measures — tonics and alteratives — and treatment of the 
nasopharyngeal lesions. 

If the photophobia becomes distressing in spite of the other treat- 
ment, it has been suggested that this may be relieved by the use of 
cocaine, a practice that by no means commends itself in corneal ulcera- 
tion, in spite of the temporary relief from the local anaesthesia. Relief 
of this symptom in many instances follows the use of a douche of cold 
water on the closed eyelids, or by touching with blue-stone the ulcer- 
ated fissure at the external commissural angle, which is commonly an 
exciting cause of the spasmodic closure of the lids. 

Ulcerative Keratitis. 

Ulcerative keratitis, or ulcers of the cornea, may be primary in 
origin — that is, the disease begins in the cornea — and may be caused by 
phlyctenular disease, injury, abscess, depressed nutrition, etc. ; or may 
be secondary, and result as the sequel of severe inflammations of the 
conjunctiva: for example, purulent, diphtheritic, or granular con- 
junctivitis. There are numerous varieties of corneal ulcers, but three 
groups only will be mentioned: simple ulcers, which form a small, 
superficial gray lesion, and are not accompanied by much vascularity 
or dread of light; purulent or deep ulcers, in which the open lesion is 
of yellowish color and is surrounded by hazy cornea; and infecting or 
sloughing ulcers (purulent keratitis), in which the ulcer assumes a 
serpiginous or creeping form, and there is usually a deposition of pus 
in the bottom of the anterior chamber (hypopyon-keratitis). Recent 
investigations indicate that typical serpiginous ulcer of the cornea 
with hypopyon is frequently caused by the Frankel-Weichselbaum 
capsulated diplococcus; that ulcers not typically serpiginous may 
originate from a staphylococcus, streptococcus, or mixed infection; 
and that a small percentage of sloughing keratitis is due to a schizo- 
mycetal infection — the aspergillus fumigatus. The various micro- 
organisms come from the conjunctiva, the ciliary borders, the nares, 



KERATITIS. 727 

and the lachrymal passage, and infect some slight abrasion on the 
corneal epithelium and thus start a dangerous form of suppurative 
keratitis. An abscess of the cornea may also occur as the result of an 
inoculation of the infected area with pathogenic micro-organisms, 
typical forms sometimes appearing during scarlet fever, measles, 
typhoid and typhus fevers, and especially during the convalescent 
stage of smallpox. Simple corneal ulcers are treated in precisely the 
same maimer as phlyctenular ulcers. The treatment of severe ulcera- 
tion of the cornea, no matter what its etiology, may be summarized as 
follows: (1) Search should be made for the cause of the ulcer, includ- 
ing careful examination for the presence of a foreign body, a misplaced 
cilium, conjunctival inflammation, lachrymonasal disease, affections 
of the rhinopharynx, carious teeth, and constitutional disorders of all 
types. (2) At frequent intervals moist heat should be applied by 
means of lint or flannel compresses dipped in water at a temperature 
of 120° F. (3) Unhealthy conjunctival discharge should be removed 
by frequent irrigations with mercuric chloride (1 : 8000), or a saturated 
solution of boric acid. (4) Sterile atropine drops (4 grains to the 
ounce [0.25-30.0]) should be instilled with sufficient frequency to main- 
tain mydriasis if there is any tendency to iritis. In the opinion of some 
surgeons, eserine {\ to \ grain to the fluidounce) is a useful drug in the 
treatment of peripheral ulcers with a tendency to perforate the cornea, 
provided there is no iritis. Recent experiences of the writer indicate that 
the value of eserine in the treatment of corneal ulcers is problematical. 
(5) The eyes should be protected with smoked glasses; but in severe 
cases and in the absence of purulent conjunctival discharge a dry anti- 
septic dressing, held in place by a light but firmly applied bandage, 
promotes healing and prevents perforation. It may be worn until the 
floor of the ulcer is covered with epithelium, and removed whenever 
the applications are required. A little iodoform may be dusted upon 
the surface of the ulcer before the bandage is applied, or the ulcer may 
be covered with an iodoform wafer. (6) If the ulcer shows a tendency 
to spread rapidly, it should be curetted and immediately afterward 
gently touched with a probe which has been dipped in pure carbolic 
acid, or with a wisp of cotton which has been dipped in a solution of 
nitrate of silver (10 grains to the ounce), tincture of iodine, or formal- 
dehyde (1:60). Of these remedies, nitrate of silver and tincture of 
iodine yield the best results in ulcers of the non-infective type; but 
in ulcers of the infective variety pure carbolic acid or nitric acid 
should be employed. (7) If the ulcer continues to spread, the actual 
cautery may be used, the glowing point of the cautery-needle being 
applied to every portion of the ulcer, the area of which is outlined 
by means of fluorescine (2.5 per cent, solution), which will color 
green any portion of the cornea deprived of its epithelium, and there- 
fore furnish a reliable guide to the extent of the destructive process. 
Before these severe applications are made the cornea should be 
rendered insensitive by a few drops of a holocain solution, and the 



728 DISEASES. 

ulcer itself painted with a cotton wisp dipped in holocain. Indeed, 
there is much evidence to show that the application alone of this drug 
has a distinct curative influence on corneal ulcers, in this respect 
differing very distinctly from cocaine, which rather retards the cica- 
trizing process. Subconjunctival injections of cyanide of mercury 
(1 : 5000) or of physiological salt solution at times yield satisfactory 
results. If an abscess forms in the cornea, the pus should be 
evacuated by an incision; and hypopyon, or pus in the anterior 
chamber may be drained by an operation after the manner of Saemisch 
— that is, by division of the corneal layers — or by a simple para- 
centesis of the cornea. 

Sequelae of Corneal Ulceration. 

After healing of a corneal ulcer the cicatrix consists of a more or 
less dense white spot in the cornea (macula). If these scars are thick 
and white, they are irremediable by local medication and require 
surgical interference for relief. If, however, they are diffuse, much 
good will follow systematic massage of the cornea, aided by the 
introduction of a small particle of yellow oxide of mercury salve. 
The massage is performed as follows: A piece of the salve the size 
of a split pea is introduced beneath the upper lid; upon the closed 
lid a finger is placed, and regular motions made through the lid over 
the surface of the cornea — namely, vertical, lateral, and radial motions, 
the seance being completed by circular movements. The whole should 
last from one to three minutes. Alleman claims excellent results in 
dissipating corneal opacities by the use of electricity by connecting a 
suitably prepared electrode with a battery, the cathode being placed 
directly on the previously anaesthetized cornea and the anode on the 
cheek. Subconjunctival injections of physiological salt solution, 
placed near the corneal margin, have some power in causing absorp- 
tion of corneal nebula. The internal administration of thiosinamin 
has been recommended; the author has never observed encouraging 
results from the use of this remedy. 

LACHRYMAL ABSCESS. 

Lachrymal abscess results from suppuration in a chronically dis- 
tended lachrymal sac owing to the presence of obstruction in the 
nasal duct, and exists as a swelling under the skin at the inner can- 
thus, pressure upon the surface causing an escape of pus through the 
canaliculi. The treatment is practically confined to surgical inter- 
ference^ — that is, division of the canaliculi and washing out the dis- 
tended sac with antiseptic fluids, and restoring the patulency of the 
nasal duct by the use of probes as soon as the inflammatory symptoms 
have subsided; or, if the skin over the seat of the abscess is thinned 
and rupture is threatened, by free puncture downward and outward. 
In purulent discharge from the lachrymonasal duct solutions of formal- 



LARYNGITIS (ACUTE). 729 

dehyde (1:6000), nitrate of silver (1:500), or protargol or argyrol 
(2 to 5:100), injected through the passage, favorably modify the 
unhealthy secretion. Much comfort will ensue from the use of hot 
compresses over the inflamed area. These may be made in the ordi- 
nary way, but are more efficacious if composed of a lead lotion, the 
ordinary lead-water and laudanum answering the purpose very well. 
Excision of the lachrymal sac is the best surgical procedure for chronic 
dacrocystitis. 

LARYNGITIS (ACUTE). 

The treatment of acute laryngitis is identical in many respects 
with that directed against acute inflammatory processes elsewhere. 
It may be divided into local, external, and internal methods. The con- 
dition of the larynx when acutely inflamed is that of intense hyper- 
emia and irritation, and the object of the physician must be to allay 
this irritability. This is best accomplished by the use of compound 
tincture of benzoin, which is placed in boiling-hot water (1 ounce to the 
pint [30.0: 480 c.c.]), and the steam inhaled as it rises from a pitcher or 
as it passes out of the nozzle of a deep coffee-pot. Another method 
consists in the use of a can or wide-mouthed bottle arranged with 
one long and one short tube like a Wolff bottle, the air being drawn 
into the larynx through the short tube, after bubbling through the 
medicated water. (See Inhalations, Part III.) This inhalation should 
be resorted to six or eight times a day, but the patient must not go out 
of doors or into a cold room, as the steam relaxes the parts involved 
and renders them more susceptible to cold. Sometimes advantage is 
gained by adding to this inhalation 1 grain (0.06) of menthol. If 
the patient is unable to remain in an equable temperature, then the 
steam inhaler should be supplanted by a nebulizer, in which should 
be placed the following mixture: 

1^— Menthol gr. iij (0.20). 

Albolene . fgj (30.0).— M. 

S. — Use as a spray. 

The patient is directed to inhale this vapor gently, which because of its 
lightness readily passes deeply into the air-passages, and has the effect of 
soothing rather than irritating them as does the spray from an atomizer. 
Rarely in the very acute stages of laryngitis should a watery spray 
be employed to wash the laryngeal mucous membrane, as it is apt to 
increase the irritation. If any aqueous spray is used, as may be nec- 
essary when the irritation has resulted from the inhalation of dust, it 
may be made up as follows: 

1$ — Sodii chlorid gr. xv (1.0). 

Acid, boric gr. x (0.60). 

Sodii borat . . gr. x (0.60). 

Aquae rosae fgiij (90.0). — M. 

S. — Use as a spray. 



730 DISEASES. 

The external treatment, if the inflammation is exceedingly severe 
and the patient can be confined to bed, consists in the application of 
a mustard plaster over the larynx, or instead a cold compress should 
be applied and kept in place with a long stocking tied around the 
neck. This soon becomes a warm compress by the heat of the body 
and may be kept in place all night. The cold followed by heat pro- 
duces excellent results. A mustard foot-bath and a warm drink on 
going to bed are useful. 

The internal treatment should consist in. opening the bowels with 
calomel and a saline purgative if constipation is present, and in the 
administration of full doses of aconite and bromide of sodium or potas- 
sium, as follows: 

1^— Tine, aconiti m xl vel lxxx (2.6-5.3). 

Sodii bromidi ^ij (8.0). 

Syr. lactucarii (Aubergier) . . . f oj (30.0). 

Aquae dest q. s. ad fgiij (90.0). — M. 

S. — Dessertspoonful (8.0) every hour until six or eight doses have been taken. 

This prescription may in many cases be continued until convalescence, 
as it checks cough, soothes the inflamed area, and allays arterial excite- 
ment. Often it is best to omit the aconite after the first few doses. 
In other cases good results follow the use of 2 or 3 minims of dilute 
nitric acid in water every half -hour or hour for 6 doses. This is useful 
in the early stages only. By the second day the patient should be 
directed to make a heavy application of tincture of iodine over the 
trachea and episternal notch, as high as is possible without the stain 
showing above the collar. In children and in some adults this is well 
substituted by oil of amber and sweet oil in the proportion of 1 to 3 
parts rubbed on the skin. 

For the laryngeal stiffness following the inflammation preparations 
of coca are very useful given internally, and tonics to the general sys- 
tem are needed. In many cases the prescription calling for ammonium 
chloride in the article on Bronchitis is useful. 

Abrams asserts that freezing the skin over the insertion of the inter- 
nal laryngeal nerve, near the thyrohyoid space, where it enters the 
larynx, is a very useful curative measure. This may be repeated 
several times if necessary. The writer has never used this measure. 

LEUCORRHCEA. 

This is a condition — vulgarly known as the " whites" — consisting 
in a hypersecretion from those glands which pour out their contents 
into the vagina or the cervical canal of the uterus, or even into the 
cavity of this organ. It is a state dependent upon many causes for its 
existence, the chief of which is a condition of the system when it is 
"run down" from any cause, with perverted functions of the glands 
or their surroundings. The character of the discharge varies with 
almost every case. In some instances it is thick and tenacious, and 



LEUCORRHCEA. 731 

in others so liquid as to trickle down the limbs and soil the clothing. 
In most of the latter cases catarrh of the Fallopian tubes or ovarian 
irritation and tenderness are present. When the secretion is very 
thick and tenacious it generally arises from the cervical canal, while 
that from disorder of the vaginal wall alone, independent of other 
morbid conditions, may be either thick or thin. 

The treatment of these forms of leucorrhcea may be divided into 
two parts — one, that directed to the remedying of the morbid process 
through the use of drugs by the mouth; the other, by their employ- 
ment locally. In obstinate cases the repair of a lacerated cervix or 
the curettement of the uterus may be necessary. 

It is needless to state that in that form dependent upon excessive 
lactation or other exhausting manner of life tonics of an active character 
are needed. As a general rule, anaemia will be present, and the follow- 
ing pill will be found of service : 

1$ — Arseni trioxidi gr. \ (0.015). 

Ferri reducti gr. v (0.30). 

Quininse sulph gr. xx (1.3). — M. 

Ft. in pil. No. xx. 

S. — One pill three times a day, after meals, for an adult. 1 



Or, 



1$ — Tr. cinchonse comp f oij (60.0). 

Tr. gentian, comp q. s. ad. f §iv (120.0). — M. 

S. — Dessertspoonful (8.0) three times a day, after meals. 



When any preparation of iron is used care must be taken that the 
bowels are kept active and that the stomach is not disordered. Asso- 
ciated with the use of these internal remedies should be a moderate 
amount of exercise and the avoidance of late hours and rich foods. 

The local applications which are of value in these states consist in 
counterirritation and vaginal injections or painting with proper fluids 
the mucous membrane of the parts from which the discharge comes. 
In the leucorrhcea dependent upon irritation of the ovaries associated 
with catarrh of the Fallopian tubes the use of small blisters formed by 
the employment of cantharidal collodion or a cantharidal plaster over 
the groin on either side is often accompanied by good results. At 
the same time the vaginal surfaces surrounding the cervix uteri may 
be painted with a mixture of iodine, carbolic acid, and chloral, such 
as was used by Goodell, as follows: 

1^ — Iodi resublimat. . ^iv (16.0)., 

Phenolis, 

Chlorali hydrati . . . . . . aa gj (30.0). 

Rub the iodine and chloral in a glass mortar into a powder and add 
the carbolic acid. 
S. — Formula. To be used by the physician only. 

1 In this prescription the small amount of iron given will probably be noted, but this 
is done advisedly, as iron does as much good to the blood in small as in large amounts under 
most circumstances. (See Iron.) 



732 DISEASES. 

The following pill may also be employed: 

1$ — Hydrarg. chlor. corros. . . • . . . . gr. \ (0.03). 
Ft. in pil. No. xx. 
S. — One pill three times a day after meals, or a tablet triturate may be used 
instead of a pill 

The remaining treatment of watery leucorrhoea consists in the use 
of astringent injections. A cheap astringent injection is made 
by adding 1 ounce (30.0) of powdered white-oak bark to each pint 
(480 c.c.) of hot water, or tannic acid and glycerin in the proportion of 
1 ounce to 2 quarts (30.0: 1920) of warm water, Ringer recommends 
the following: 

1$ — Sodii bicarbonatis 3J (4.0). 

Tincturae belladonna? f^ij (8.0). 

Aquse Oj (480 c.c.).— M. 

S. — Use as a vaginal wash. 

Where the discharge is fetid a solution of permanganate of potas- 
sium should be used as an injection in the strength of \ drachm to 1 
pint (2.0: 480 c.c.) of water. 

In purulent vaginitis, specific or otherwise, the following injection 
is serviceable: 

3— Creolin f^ss vel fgij (2.0-8.0). 

Fluidext. hvdrast. canaden. . . t'zijss (10.0). 

Aqu« fgviij (240.0).— M. 

S. — Add 2 tablespoonfuls to a pint (30.0 : 480 c.c.) of hot water, shake 
thoroughly and use as an injection. 

A very useful astringent injection is: 

1$ — Zinc, sulphat. . . ..... 3j (4.0). 

Alumin. sulph 3i (4.0). 

Glycerini . . . fgvj (180.0).— M. 

S. — A tablespoonful (16.0) to each quart (1 litre) of water. 

The injected fluid should always be as hot as the patient can bear, 
as tepid injections are harmful. 

Sometimes a tampon thoroughly saturated with a powder of iodo- 
form and tannic acid, equal parts, and packed around a discharging 
uterine cervix, is of service. 

When using vaginal injections in females it is important to remem- 
ber that they should be in large quantities. Nothing is more antago- 
nistic to true asepsis than the usual manner in which these applications 
are made. Often a pint of the solution is placed in a basin over which 
the woman squats, and by means of a syringe forces the liquid into the 
vagina as fast as it runs out, thereby filling the syringe joints with the 
dissolved secretions, and returning to the vagina as soon as they flow 
away the impurities which have left it. The only proper way to give 
such an injection is to use a fountain syringe or to have the solution in 
one basin, to the extent of 1 gallon (4 litres), while the patient squats 
over a second basin, into which the impure liquid may run. 



MANIA (ACUTE). 733 



LID ABSCESSES. 

Lid abscesses are seen more frequently in children than adults, as 
the result of injury, the sequel of acute illness (epidemic influenza, 
pulmonary catarrhs, fever, etc.), or from local infection; under the 
latter circumstance they may assume a gangrenous type. The treat- 
ment is that for any form of abscess—poultices, preferably in the form 
of hot compresses, early incisions, antiseptic solutions, and tonics. 

LUMBAGO. 

This is a form of myalgia or muscular rheumatism of the muscles 
of the loins and small of the back, and is frequently the result of lifting 
heavy weights or it is due to other strains. In many cases acu- 
puncture is very useful, particularly if the trouble is bilateral. (See 
Part III.) Sometimes after the employment of this measure the 
patient can straighten the back at once and retain that position. In 
other instances of antipyrin or acetanilid, in 5- to 10-grain (0.30-0.60) 
doses of the former and 4- to 8-grain (0.25-0.5) doses of the latter are 
of service, and iodide of potassium and salicylic acid are not to be 
forgotten if the condition of the patient does not rapidly improve. 
Phenacetin and phenyl salicylate are also useful, combined or alone. 
A large hot poultice applied to the back is often efficacious in obstinate 
cases. Sometimes the use of a hot foot-bath and a Dover's powder on 
going to bed will produce a cure, and ironing the back with an ordinary 
hot laundry iron at a proper heat, a piece of newspaper or cloth being 
placed over the skin under the iron, is very efficient. Counterirritation 
in the shape of a blister, a mustard plaster, or capsicum draft will 
often give relief. 

Where these measures fail, an ether or chloride of ethyl spray may 
be played on the centre of the painful area until the skin is greatly 
blanched. 

MALARIAL FEVER. 

(See Intermittent and Remittent Fevers and Pernicious 
Malarial Fever.) 

MANIA (ACUTE). 

Space is wanting to consider the thorough and complete treatment 
of mania as it comes to the neurologist. All that can be mentioned 
here are temporary measures suitable for cases which are brief in 
their course. 

In those cases which occur after confinement and are not supposed 
to be based upon permanent trouble, cimicifuga racemosa is said to 
be very useful in the dose of 20 to 30 minims (1.3-2.0) of the fluid 
extract three times a day. 

For the rapid quieting of the patient hyoscine hydrobromide may 



734 DISEASES. 

be used hypodermically in the dose of T ^ 7 grain (0.0006). In other 
instances, if the kidneys and heart are healthy, full doses of chloral 
may be used; and if an active preparation of cannabis indica can be 
had, at least 1 grain (0.06) of the solid extract or \ to 1 drachm 
(2.0-4.0) of the tincture should be employed. Cannabis indica will 
be found much more serviceable if 60 grains (4.0) of one of the 
bromides be combined with it. 

Where a patient suffering from mania is so violent that nothing can 
be done with him, he should be held, and an emetic dose of -^ grain 
(0.005) of apomorphine be given hypodermically to produce vomiting 
and so relax the muscular system; or he maybe tied or anaesthetized 
sufficiently to enable the physician to administer proper remedies. 
Sometimes full doses of morphine are needful or a cold douche to 
the head while the body is in a tub of hot water is of service. In still 
others a hot steam bath or Russian bath is a valuable sedative. 

MELANCHOLIA. 

This is not the place for the discussion of melancholia of so severe 
a form as to amount to insanity, since the treatment of this latter state 
is very various and largely depends upon the skill of alienists. 

There is one form of melancholia, however which may often be 
quickly relieved by a simple measure. It is that dependent upon the 
condition of the system in which oxaluria is present. Whenever an 
individual complains of melancholia the urine should be examined, 
and if oxalate crystals are found, the undiluted, freshly made nitro- 
muriatic acid should be given in the dose of 5 minims (0.3) after 
each meal in a half-tumblerful or more of water. In order to guard 
against errors in diagnosis it is well to remember that pears, tomatoes, 
rhubarb, and cabbage all cause oxalates to appear in the urine for a 
short period after their ingestion. 

MENINGITIS (ACUTE). 

In a large proportion of cases the development of meningitis is 
secondary to some other state of disease, as, for example, typhoid fever 
or croupous pneumonia. Under these conditions the treatment 
must be governed by the exciting cause. In meningitis following 
injury to the head or arising primarily, the treatment is that of any 
other form of acute inflammation occurring in a sthenic or dynamic 
individual, and particularly does its treatment correspond to that of 
the other inflammations of large serous membranes, such as peritonitis 
or pleurisy. 

In the early stages, if the pulse is full and bounding, the patient 
should receive sufficiently large doses of aconite or veratrum to 
impress the circulatory system strongly. These drugs have the power 
of producing such dilatation of the bloodvessels throughout the body 
that the congested or inflamed area is relieved of its excess of blood, 



MENINGITIS {ACUTE). 735 

because, the pressure being low elsewhere, the blood obeys the law 
that liquids always seek escape from pressure, and so leaves the 
meninges of the brain for the vessels of the limbs and trunk. 

The proper dose of veratrum in the form of the tincture is 10 
minims (0.60) every hour until the skin becomes moist or nausea is 
developed. 1 The tincture of aconite is also useful in full dose. If 
great arterial excitement is present, venesection may be practised 
(see Bleeding), but veratrum and aconite are better remedies if they 
are at hand. They are, of course, contraindicated if the circulation is 
feeble. Associated with these two drugs mercury and opium should 
be employed, the first for its antiphlogistic influence, the second for its 
power in allaying irritation. \ grain (0.015) of powdered opium and 
i grain (0.03) of calomel may be given every hour until the full effect 
of the opium or mercury is manifested. In some instances the tincture 
of deodorized opium ( Tinctura opii deodorati) is better than the crude 
drug, in the dose of 2 to 5 minims (0.1-0.30) every one or two hours. 
Sometimes belladonna is of great service, and this is particularly the 
case where the drugs already named are contraindicated because of a 
condition of weakness or asthenia. A good-sized blister may be 
placed at the nape of the neck as a counterirritant with the hope that 
it will prevent effusion. 

During the first acute stage an ice-bag should be applied to the head 
both for its local influence and its antipyretic effect, and leeches 
may be put at the nape of the neck with advantage. As the disease 
advances and the nervous disorders of the affection become marked, 
sedatives are required to allay the twitchings, muscular spasms, or 
convulsions, and for this purpose no drugs excel chloral and the 
bromides. The doses to be used vary with the violence of the symp- 
toms, but it may be stated that the chloral should rarely, if ever, be 
used in doses above 10 grains (0.60), and the bromides given in the dose 
of from 5 to 40 grains (0.3-2.60). If coma comes on, a large blister 
should be applied to the nape of the neck. 

Quinine has been recommended in meningitis, but it is absolutely 
contraindicated, as it predisposes to meningeal congestion. It may be 
employed only in convalescence, and then used most carefully. 

The treatment of the advanced stage of meningitis must be neces- 
sarily supportive. Alcohol should be given with the food if weakness 
is present, and a very simple or milk diet insisted upon. 

If symptoms of cerebral pressure are marked, lumbar puncture 
should be performed, the technique of which is described under 
Cocaine. Of course, no cocaine is injected. In many cases the relief 
is only temporary, but in a few it is permanent. 

1 It is to be remembered that veratrum often causes nausea, and even vomiting, in sus;e o Dtible 
persons, and in consequence it should be carefully given in meningitis, lest if vomiting come 
on the condition be made worse, 



736 DISEASES. 



MIGRAINE. 



Migraine is a form of head pain usually limited to one side of the 
head — hemicrania. It is often characterized by the presence of 
severe boring pain in the eyeball or over the brow on one side. Asso- 
ciated with or preceding this pain there may be some dimness of vision 
or even a true transient amblyopia. The exact pathology is not clear, 
and so our treatment of it is perforce largely empirical. Before the 
introduction of the coal-tar products as pain-relievers, the best treat- 
ment of the attack of pain consisted in ordering the patient to bed and 
giving him 15 to 30 drops (1.0-2.0) of tincture of gelseminum, with j 
to \ grain (0.015-0.03) of extract of cannabis indica every two hours. 
If the heart is feeble, the fact that gelseminum is a cardiac depressant 
must not be forgotten. So far as the other measures for relief of the 
individual attack of pain are concerned, reference should be made 
to the article on Neuralgia. For the cure of the condition which 
results in the attack, the endeavor should be to keep the liver active, 
since the failure of this organ to destroy the poisons which cause an 
attack, and its failure to prevent fermentation in the bowel by the 
proper secretion of bile, is supposed to be the chief cause of the disorder. 
The use of a mild cholagogue like sodium phosphate, taken in hot 
water every morning on first rising, does good in many cases, particu- 
larly if the patient also takes some one of the salicylates several times 
a day. Rachford has recommended the use of the following prescrip- 
tion in such cases: 



& — Sodii sulphatis 



Sodii salicylatis 1 
Magnesii sulphatis 
Lithii benzoatis 
Tinct nucis vomicae 
Aqua? destillat . 



gr xxx (2.0). 
gr. x (0.60). 
gr. 1 (3.3). 
gr. v (0.3) 
miij (0.2). 
fgiv (120.0).— M. 



This mixture should be made up in large quantity and placed in a 
siphon by one of the concerns which charge soda-water, and from one- 
quarter to one-half glass of this water at ordinary temperature is to be 
taken every morning at least half an hour before breakfast, enough being 
used to insure an adequate bowel movement during the forenoon. 
The ingredients meet several indications, for the sulphates of sodium 
and magnesium act as laxatives, the salicylate of sodium acts as a 
gastrointestinal antiseptic and cholagogue, and the lithium benzoate 
presumably aids in the elimination of uric acid, or, to speak probably 
more correctly, aids in the elimination of effete materials representing 
perverted metabolism. The small dose of nux vomica is introduced 
to mask the soapy taste of the mixture. Associated with this treat- 
ment additional doses of salicylates may be used if needed, or benzoate 
of sodium may be given. The author prefers 10- to 20-grain doses of 
ammonium benzoate given in capsule. When evidences of intestinal 

1 The salicylate should be derived from natural sources and not be the synthetic variety. 



MYALGIA. 737 

fermentation are marked, the following pill may be used, devised by 
M. Allen Starr; it should be coated with phenyl salicylate to insure 
its entrance into the bowel before it is dissolved : 

1^ — Sodii phenolsuiphonat gr. v (0.3). 

Potassii permanganatis gr. j (0.06). 

Beta-naphtol gr. j (0.06).— M. 

S. — One after meals and at night. 

An occasional free catharsis with blue mass is advisable in many of 
these cases. Usually 5 to 10 grains (0.3-0.60) once a week and fol- 
lowed by a saline is sufficient. It is essential that all causes of sys- 
temic and nervous worry be removed in these cases. Excessive 
sexual indulgence is often a cause of the attacks, and it must be inter- 
dicted. (See also articles on Headache and Neuralgia.) 

MUSCJE VOLITANTES. 

Muscat volitantes is the name applied to the dark specks which 
patients frequently see floating across their fields of vision, especially 
if the eyes are directed toward a bright sky or a white page. Usually 
they indicate no disease of the vitreous humor, and the ophthalmo- 
scope fails to detect abnormal changes. They are attributed to tor- 
pidity of the liver by the laity. Muscat volitantes may indicate eye- 
strain, and if the refraction is abnormal this should be corrected; a 
mild course of alteratives is often a useful adjuvant. 

MYALGIA. 

Soreness of the muscles either on pressure or on movement may be 
dependent upon a number of causes, such as strains, bruises, toxaemia, 
or inflammation due to cold. Here, as in many other states, the treat- 
ment should be divided into the external and the internal methods. 
Of the internal remedies, the best are the salicylates or the iodide of 
potassium if rheumatism be the cause of the trouble. On the other 
hand, if a bruise or cold be the cause, the chloride of ammonium will 
be of service in 10- or 20-grain (0.60-1.3) doses given in a solution 
with fluid extract of liquorice. (For prescription see Bronchitis.) 
Other remedies which may be tried with a good chance of success are 
full doses of an active fluid extract of cimicifuga (20 minims to 1 drachm 
[1.3-4.0]) or the citrate or acetate of potassium in 20-grain (1.3) doses. 

The local medications are numerous, but only a few can be consid- 
ered as worthy of routine employment. The chief one is iodine, in 
the form of the pure ointment or the ointment diluted one-half with 
lard if the skin is easily irritated. Another method is to employ a 
liniment, well rubbed into the skin, made up as follows: 

I$— Tr. belladonna? f^iss (6.0). 

Tr. aconiti fgvi (24.0). 

Tr. opii f3ij (8.0). 

Liniment, saponis . . . . q. s. ad f §vj (180.0). — M. 
S. — Poison. To be used externally and only as a liniment 

47 



738 DISEASES. 

Sometimes chloroform liniment is singularly successful, and poul- 
tices applied as hot as can be borne and covered by oiled silk and cotton 
to retain the heat are often of great value. Massage or good rubbing 
is also a sine qua non for the successful treatment of this state. 

NASAL CATARRH (ATROPHIC). 

In atrophic nasal catarrh the nostrils are roomy and the mucous 
membrane red and shiny. The, formation of connective tissue has 
to a great degree obliterated the delicate serous glands, and the dis- 
charge of mucus, no longer diluted, forms inspissated crusts, which 
adhere to the mucous membrane of the septum and turbinated bones. 
Areas of ulcerated or abraded membrane are disclosed upon removal 
of these adherent crusts. 

The turbinated bones are gradually absorbed and the secreting 
surface thereby much reduced. Sometimes the wasting is so great 
that the posterior wall of the pharynx is clearly visible through the 
anterior nares. The inspissated secretion may form a cast of the 
nostril, and as fresh layers form underneath, the oldest part is raised 
until the whole interior of the nostril becomes a mass of decomposition, 
giving rise to an overpowering stench. This form of catarrh causes 
loss of the sense of smell, and the odor is not recognized by the patient 
himself. Ulceration or caries of the bony structure produces an odor 
even worse than the so-called ozama. The pharynx suffers from the 
general wasting, and presents a dry, varnished appearance called 
pharyngitis sicca, which is rather a symptom of nasal atrophy than 
a separate disease of the pharynx. 

The indications are the removal of all accumulations in the nose 
and nasopharynx and the healing of abraded or ulcerated surfaces. 
The early removal of dead bone is imperative, and what secreting 
surface remains must be stimulated as far as possible, to compensate, 
in a measure, for the glands that are hopelessly destroyed. In other 
words, efforts are directed toward producing a compensatory hyper- 
trophy of the glandular tissue that remains. Therefore with the use 
of antisepsis alteratives and local stimulation are combined. 

The nose should be thoroughly cleansed with an alkaline wash — 
Dobell's solution — warmed to increase its solvent power. To relieve 
the odor, we may increase the amount of phenol or substitute for it 
eucalyptol and thymol in the wash. Euthymol contains both of these 
and may be added to the wash. Its own pungent odor masks some- 
what the offensive odor. Permanganate of potassium may be used in 
weak solutions, but it is painful except when sensation is entirely lost. 
Peroxide of hydrogen is valuable used in an atomizer in the strength 
of 1 part to 10 or 1 to 20. After this has softened the crusts they 
should be dislodged by the further use of a warm alkaline spray, and 
after the cleansing is complete ichthyol, pure or diluted one-half with 
water or albolene, is applied by means of an applicator. Often a much 



NASAL CATARRH {CHRONIC). 739 

weaker solution of ichthyol will do equally well. The patient may be 
given a salve of: 

fy— Ichthyol . . . gr. xl (2.6). 

Menthol gr. v (0.3). 

Petrolat. alb . . . oj (30.0).— M. 

A piece of this is to be inserted into the nostril, after using a douche, 
each night. 

The solutions are best applied by means of an atomizer, or post- 
nasal syringe in the hands of the physician, or by snuffing from the 
hand or cup. 

The odor, if due to decomposition, is much decreased as soon as 
the passages are clear. The discharge must never be allowed to 
reaccumulate or much gain will be lost. 

Ulcerations require local stimulation by a strong solution of nitrate 
of silver or a superficial application of the flat surface of the galvano- 
cautery heated to dull redness. Necrosed bone should be removed, 
and it is often found detached in the nostril. 

Local stimulants should be judiciously combined with alteratives. 
Powders of nitrate of silver in starch, varying in strength from 1 to 
10 grains to 2$ drachms (0.06-0.60: 10.0) of the latter, may be blown 
into the nostrils by means of an insufflator. Cover gently the whole 
surface with a thin layer, and use it only of sufficient strength to be 
slightly felt. Nitrate of silver in solution, 1 to 10 grains to 1 fluidounce 
(0.06-0.60 : 30.0) gives better results at other times when applied to 
the mucous membrane. The physician must avoid overstimulating, 
and so exhausting, the glands which it is wished to strengthen. The 
use of alteratives may alternate with the silver salt and iodide of potas- 
sium, and this may be done by using solutions of iodine and glycerin, 
as recommended for hypertrophic nasal catarrh. Internally, we may 
employ iodide of potassium, to increase nasal secretions, and mucous- 
membrane stimulants and tonics. Attention should also be paid to 
the activity of the skin. 

NASAL CATARRH (CHRONIC). 

Chronic nasal catarrh is essentially a disease of civilization, which 
may occur at any period of life, but more commonly develops from 
youth to early adult life. 

Although very prevalent among the upper classes, it is in the lower 
ranks that it most frequently reaches its later stages and its worst 
forms. This does not result from lack of opportunity for treatment, 
but from the ignorance or indifference which this class show to dis- 
eases while there is no suffering and no interference with business. 

Hypertrophic nasal catarrh commonly has its origin in a neglected 
cold in the head or in a series of colds occurring in rapid succession, 
keeping the nose in a congested state until the erectile tissue covering 
the turbinated bones loses in a measure its power of contracting, and, 



740 DISEASES. 

decreasing the calibre of the nostrils, becomes a source of permanent 
obstruction to breathing. 

As the disease advances there is increased susceptibility to cold. 
Slight exposure produces a stuffy feeling in the nose. The nostrils 
may become completely occluded; usually, however, only one side 
at a time is obstructed at first, the obstruction showing a tendency 
to change sides. This change is most noticeable on turning in bed, 
the lower side usually stopping, and on changing the posture the 
obstruction is reversed, the clearing being accompanied by a crackling 
sensation. A slight tickling cough and tendency to clear the throat 
in the mornings may result from irritation of the pharynx or larynx. 

The first indications for treatment are the reduction of inflammation 
and restoration of the breathing-space. 

As the chief function of the nose is respiratory, the re-establishment 
of free nasal respiration, combined with the liberal use of antiseptic 
washes, will lessen the inflammation and irritation and produce a 
healthier state of the secretions. 

The writer places cleanliness at the head of the list of remedial 
measures. The alkaline wash recommended on page 620, sprayed 
into the nose by a hand atomizer or gently snuffed from the palm of 
the hand or from a small cup, gives good results. The hand warms 
the solution slightly, but when snuffed from a cup the solution should 
be artificially warmed. This wash may be used two or more times a 
day. 

The nasal douche should never be used where there is nasal obstruc- 
tion, on account of the risk of forcing the solution into the Eustachian 
tube and causing catarrh of the middle ear. 

In addition to the antiseptic wash where the mucous membrane is 
congested and irritable, the treatment recommended ■ for coryza may 
be instituted for a few days with good results. A solution com- 
posed of equal parts of water of hamamelis and water or a dilute 
solution of hydras tis may be sprayed into the nose during the acute 
stage. 

A little latter a spray of ferric alum, 5 grains to the ounce (0.3-30.0), 
may be applied carefully in an atomizer by the physician. It is not 
advisable to use alum in any considerable strength in the nose, as its 
continued use is liable to impair the sense of smell. 

The alterative and absorbent action of iodine makes it a valuable 
remedy for local application in very chronic nasal catarrh. It should 
be combined with glycerin in the strength of 6 or 8 grains to the ounce 
(0.40-0.50 : 30.0), with enough potassium iodide to make a solution. 
Apply this by means of a piece of absorbent cotton on the end of an 
applicator, along the floor of the nose, until it reaches the pharynx. It 
is needless to say that such an application as this should be made with 
the utmost gentleness. The cotton should project beyond the probe, 
and care should be taken to avoid bruising the tissues. 

After the irritation has subsided, as shown by the disappearance 



NEPHRITIS {ACUTE). 741 

of the livid color and lessened sensibility, any remaining hypertrophied 
tissue should be removed by a snare or the galvanocautery. 

NEPHRITIS (ACUTE). 

In the early stage of onset, for the reduction of inflammation cir- 
culatory depressants are to be resorted to, and aconite is generally 
most serviceable. The patient should be kept quietly in bed and 
given a milk diet, and hot compresses, cups or leeches used over 
the loins if the urine is scanty. Blisters are not advisable, as the 
irritant substances producing them may be absorbed and cause in- 
creased renal irritation. The resdessness will generally be quieted 
by the aconite; but if this fails, resort must be had to bromides or 
small doses of opium, which must be given cautiously, as these drugs 
are not readily eliminated when the kidneys are diseased. Cannabis 
indica is thought to be of great service if blo'ody urine is present, but 
chloral is generally too irritating to the kidney to justify its employ- 
ment. The appearance of large amounts of blood in the urine at 
about the fifth day of the illness is an indication, according to Sydney 
Ringer, for the use of drop doses of tincture of cantharides, given 
every few hours. Personally the author would be afraid to use this 
method of treatment. 

Should the urine be scanty and of high specific gravity, and con- 
stipation be present, some calomel, followed by a purgative dose 
(J an ounce [16.0]) of sulphate of magnesium should be used to aid 
in the elimination of impurities by the bowel. Warm mucilaginous 
drinks, as flaxseed tea, are of service, and the use of the citrate of 
potassium and the sweet spirit of nitre with copious draughts of pure 
water should be resorted to to increase urinary flow and promote the 
action of the skin. 

If dropsy or symptoms of uraemia (see Uraemia, Part IV.) come on, 
they may be relieved by the use of hydragogue purges, such as elate- 
ritim, which is particularly useful in that it is supposed to aid in the 
elimination of urea by the bowel. If vomiting is present, elaterium 
ought not to be used, as it irritates the stomach. Jaborandi or pilo- 
carpine may be used to sweat the patient at this time or in the earlier 
stages with advantage; \ grain (0.008) of the hydrochloride should be 
given hypodermically, and repeated in fifteen minutes if no sweat 
appears; but it should never be forgotten that when the heart is feeble 
or the patient very susceptible pilocarpine may produce serious col- 
lapse. This can sometimes be guarded against by the simultaneous 
use of strychnine in -^ grain (0.003) doses. Hot-air baths are often 
useful to provoke sweat and are much safer than pilocarpine. (See 
Heat, Part III.) 

The treatment of the later stages consists in the use of stimulants 
to the kidneys to arouse them from the atony consequent upon the 
excitement of inflammation. To this end digitalis and squill, or digi- 



742 DISEASES. 

talis and calomel, or caffeine citrate, may be used in small amounts, 
or in their place the compound spirit of juniper or gin may be used as 
the case progresses. If the renal structure is persistently atonic, \ to 
1 minim (0.025-0.05) of the tincture of cantharides at each dose may 
be used, and, as ansemia is often a prominent symptom, tincture of 
the chloride of iron, which is both a diuretic and a tonic, should be 
resorted to. If renal hemorrhage is excessive, gallic acid and ergot 
are indicated to control the bleeding. A milk diet should be rigidly 
enforced. 

NEPHRITIS (CHRONIC). 

The treatment of chronic nephritis is a very different matter 
from that devoted to the cure of the acute form. It is almost, if 
not quite, impossible to cure the condition present, and we can only 
strive to improve the state of the kidneys and other organs by care 
and the use of proper drugs. As Tyson has aptly put it, we must 
try to arrest the development of the renal lesions and improve the 
general health, treat the symptoms which are not dependent upon the 
nephritis, except indirectly, and, last, treat those signs which are due 
to the nephritis itself. To arrest the disease all alcoholic drinks 
should be avoided as far as possible, and business cares and worries 
be cast aside. Great care should be taken to avoid cold v and a warm 
climate is generally to be recommended to the patient, since sudden 
changes of temperature tend to produce congestion of the kidneys by 
the chilling of the skin. 

The diet and drink are important considerations, and should con- 
sist largely of milk. Many physicians direct that skimmed milk be 
used. The author believes that this advice is not wise, as it deprives 
the patient of the nutritive fats, which he needs and which are not 
contraindicated, whereas the proteids of skimmed milk, while they are 
the best form of albuminoid food we can give, are not so advantageous, 
but have to be used to maintain nutrition. If the cream in the milk 
disagrees with the patient, it may be removed or the milk may be 
diluted with some effervescent water like Vichy. 

The treatment suggested so far is applicable to all forms of chronic 
nephritis, but there are symptoms and complications of both the inter- 
stitial and parenchymatous forms of the disease which require special 
treatment. If the urine be scanty in the parenchymatous form, and 
the heart is feeble, digitalis and caffeine are useful to improve the 
renal circulation and act directly on the kidney. In other cases we 
may prescribe the well-known pill of digitalis, squill, and calomel. 
These drugs not only increase urinary flow, but also decrease albumi- 
nuria in many cases. In still other instances we may give the acetate 
and bitartrate of potassium as diuretics, which are particularly valuable 
if combined with digitalis in those cases of albuminuria dependent 
upon failure of the heart muscle. These remedies are also of value 
to relieve the dropsy, and one of the most efficacious forms of treat- 



NEURALGIA. 743 

ment is a combination of the hitartrate of potassium and juniper- 
berries, so that 1 ounce (30.0) of the former is dissolved in 1 pint 
(480 c.c.) of an infusion (1 ounce (30.0) to the pint) of the latter and 

taken in twenty-four hours. A most valuable aid in decreasing the 

... * - ... " 

albuminuria is the use of 1 minim of tincture of cantharides in water 

three times a day, particularly if the kidneys seem torpid and are secret- 
ing too little urine. If dropsy develops (see Dropsy), hydragogue 
purges are useful, such as jalap and elaterium. 

Very great benefit can often be obtained from the use of nitroglycerin 
when the arterial tension is high, giving it in ascending doses beginning 
with y-jjQ- grain (0.0006) three times a day. This decreases the albu- 
minuria, if it is present, lowers arterial tension, and benefits the heart. 
Copious draughts of pure water should be given, if the urine be scanty 
and dropsy is not present, to flush the kidneys if possible and aid 
sweating, although copious urination may in many cases be present 
and troublesome. Another drug of value in those cases of chronic 
contracted kidney which have their origin in gout or syphilis is iodine 
in the form of iodide of sodium. This may be given in 10-grain ( 0.60) 
doses three times a day with great advantage to old persons with well- 
advanced atheromatous changes. The treatment of uraemia, should 
it be mild or severe, is important, and the reader is referred to the 
article on that subject (see Uraemia). The various forms of hot baths 
should also be employed to aid the skin in eliminating poisons and so 
relieve the kidney. The anaemia in parenchymatous nephritis is to be 
combated by the use of the tincture of the chloride of iron, or Basham's 
Mixture (see Iron), and oxygen inhalations. It is, however, a mistake 
to use large doses of Basham's Mixture. Chronic parenchymatous 
nephritis is an incurable disease, and the most that Basham's Mixture 
can do is to combat the anaemia and act as a diuretic. Small doses of 
iron will do as much for the anaemia as large ones, and will not disorder 
digestion, and the diuretic effect can be obtained by using liquor 
ammoniae acetatis if it is desired. 

In the interstitial form of the disease iron must be used with caution, 
or not at all, as it is apt to produce headache and perhaps conduces to 
the development of uraemia. It is in this form of renal disease that 
nitroglycerin does the most good by lowering arterial tension and so 
saving the heart from excessive labor. In cases in which the kidney 
is suspected of being inadequate by reason of disease, we may give 1 
grain (0.06) of methylene blue in water, hypodermically. If the color 
appears in the urine in an hour, the kidney is probably fairly active. 

NEURALGIA. 

Like headache, neuralgia gives rise to much of the suffering expe- 
rienced by active persons who are not sick enough for bed. It affects 
people in every walk of life, and may be so severe as entirely to inca- 
pacitate the most powerful men. 



744 DISEASES. 

The causes of neuralgia are very various, but they may be briefly 
stated to depend chiefly upon malnutrition and anaemia, overwork, 
nervous excitement with consequent reaction, and upon reflex irrita- 
tion from diseased organs, as in the case of supraorbital neuralgia from 
eye-strain or pelvic neuralgia from ovarian irritation or uterine inflam- 
mation. Nerves functionally diseased are always more or less active 
than normal; that is, hyper-excited, or depressed, above or below par. 
In both cases they must be brought back to their normal tone by 
appropriate remedies, and these consist in nervous excitants and 
nervous sedatives. To give a nerve already depressed the additional 
depression of a bromide, or a nerve excited the additional excitement 
of strychnine, is harmful. 

From what has just been said, it becomes evident that the physician 
must always determine the condition of the system of his patient and 
the causes of the neuralgia before administering remedies. 

The treatment of neuralgia, from its curative standpoint, may be 
divided into the use of tonics, nutritives, and palliatives. 

Where neuralgia is associated with anaemia no hope of permanent 
relief can be looked for unless iron and arsenic are used until the 
ansemia is cured, and it is often necessary to combine with these drugs 
the use of cod-liver oil and bitter tonics. These are the cases, too, 
in which nux vomica and strychnine raise the depressed nerves to 
increased activity, and so bring relief. How they do this is not known, 
but we know enough to recognize one or two important facts. Strych- 
nine is certainly a nervous stimulant, and is also a stimulant to the 
anterior columns of the spinal cord. It probably also acts upon the 
trophic centres in the anterior cornua of the spinal cord, and by stimu- 
lating these centres increases the nutrition of the tributary nerve-fibres. 

It is needless to state that the neuralgias of syphilis and tuberculosis 
are to be treated by the remedies usually directed to the relief of these 
affections, while at the same time the pain itself is carefully controlled 
by appropriate palliatives. 

When nervous exhaustion causes neuralgia, phosphorus is a useful 
remedy, particularly in those cases which are convalescing from acute 
fevers. 

Sometimes malarial poisoning produces a violent form of supra- 
orbital pain known as "brow ague," which is to be relieved, not by 
ordinary remedies, but by large doses of quinine. 

The relief of the states producing neuralgia having been spoken of, 
it yet remains to consider the measures' to be adopted for the cure 
of an attack. Fortunately, the recent advances of therapeutic study 
have placed in our hands a large list of drugs not apt to produce 
a habit after prolonged use, comparatively safe though active* and not 
of disagreeable taste or evil general effect. By these terms the writer 
refers to antipyrin, acetanilid, citrophen, and phenacetin, all of which 
possess wonderful power in the alleviation of pain dependent upon 
true nervous involvement. In order to avoid failure in the use of these 



, 



NEURALGIA. 745 

drugs in the relief of headache, we must always remember that their 
field of service is that of neuralgic pain, not other pains. Antipyrin 
is to be used in the dose of 5 to 10 grains (0.30-0.60) for ordinary 
neuralgia and more for the pain arising from the crisis of locomotor 
ataxia, acetanilid in the dose of 3 to 8 grains (0.20-0.5) for the same 
purposes, and citrophen and phenacetin in the same amount as acetani- 
lid. 

Upon these remedies, combined with caffeine and the bromides 
according to circumstances, we now depend, and the following pre- 
scriptions will be found of service: 

Jy — Antipyrinae gr. xxx vel 3j (2.0-4.0). 

Caffeinae citratae . . . . ■. . gr. xx (1.3). — M. 
Ft. in chart. No. x. 
S. — One every thirty minutes till relieved. 

The following may be of use also : 

Py— Antipyrinae gr. xxx vel 3 j (2.0-4.0). 

Potassii bromidi oiij (12.0). — M. 

Ft. in chart. No; x. 
S. — One every thirty minutes till relieved, or until six doses have been taken. 

Or, when the caffeine in the first prescription causes nervousness, 

Py — Antipyrinae gr. xxx vel 3 j (2.0-4.0). 

Caffeinae citratae . . . . . . gr. x (0.60). 

Potassii bromidi 3iij (12.0). — M. 

Ft. in chart. No. x. 
S. — One as above. 

In any one of these prescriptions acetanilid or phenacetin may be 
substituted for the antipyrin, and they should be used in preference to 
it if the heart is weak. 

A very effective remedy in some cases of neuralgia of the fifth nerve 
is croton chloral in from 5- to 20-grain (0.3-1.3) doses in pills or 
capsules of 5 grains (0.3) each. 

In some cases of anaemic neuralgia of the head nitrite of amyl 
inhalations have proved useful, probably by reason of the cephalic 
flushing produced by this drug. 

A very large number of local applications have been used with success . 
in obstinate neuralgias and other cases not so difficult of cure. Cocaine 
cannot be applied, as it does not penetrate the skin, but relief can 
sometimes be obtained by the local use of the oleate of aconitine 
painted over the spot if it be limited in area. Much of this alkaloid 
should not be applied, lest poisoning by absorption occur. 

Where the nerve is very superficial it can often be treated by cold 
with great success. This is accomplished by freezing the parts with 
an ether, chloride of methyl, or rhigolene spray, or by the application 
of a small package of finely-chopped ice and salt to the part. 

Within the last few years the treatment of neuralgia by kataphoresis 
(see Part III.) has come into prominence, and consists in the use of 



746 DISEASES. 

some anaesthetic such as chloroform, which is applied over the part on 
a small piece of lint, and a galvanic current used through the pledget 
which is attached to the positive pole. Under these circumstances 
the anaesthetic passes through the skin and affects the nerve. 

A very useful injection in neuralgia is ^ to \ grain (0.012-0.015) of 
morphine, but the danger of beginning the morphine habit is to be 
remembered when treating chronic cases. Sometimes acupuncture 
(see Part III.) is of service, and the surgeon may be called upon to 
stretch the nerve or to do a neurectomy. 

In some cases repeated doses of castor oil, 1 to 2 ounces (30.0-60.0) 
a day, seem to exercise a very extraordinary influence in relieving neu- 
ralgic pain. Such cases probably depend upon deficient activity of 
the bowel with retained toxic material which gains access to the blood. 
(For Migraine, see article on that subject.) 

NIPPLES (SORE). 

Whenever the nipples become sore, so that it is impossible for the 
mother to allow the child to nurse, a solution of cocaine of the strength 
of 4 grains to the ounce (0.25-30.0) should be applied to the part and 
washed off carefully just before the child sucks. Following the nurs- 
ing, a solution of boric acid, of the strength of 20 grains to the ounce 
(1.3-30.0) of water or mucilage of acacia, may be used over the part, 
the nipple being first thoroughly dried. Where the fissures are deep 
and slow to heal the tip of a stick of silver nitrate may be applied to 
them with advantage. Some practitioners employ tincture of benzoin 
over the inflamed part, and glycerite of tannin is often of value. Clean- 
liness, dryness, and care of the breast previous to parturition do much 
toward preventing the condition. 

Sometimes it is necessary to use a breast-pump or nipple-shield 
before a cure can be effected. 



OBESITY. 

Whenever an excess of fat accumulates in the body, various dis- 
comforts, both mental and physical, arise, and in addition the normal 
functions of all the parts are so disturbed or interfered with that the 
continuance of health is often impossible. In many cases the deposi- 
tion of fat about the heart or between its fibres results in serious symp- 
toms; and breathlessness on exertion is produced by the obstruction 
which is offered to the free movements of the diaphragm by masses of 
omental fat, aided by the fact that the great weight and bulk of the 
body require severe muscular effort. It is worthy of note, also, that 
a layer of fat over the body increases the vascular surface very greatly, 
and in consequence gives the heart the labor of supplying a larger 
number of bloodvessels. 

In many families there is an inherited tendency to obesity, while in 



OBESITY. 747 

others only certain individuals are affected. These persons are fat 
because their systems naturally tend to the deposit of obese materials, 
in the same way that the members of one family have large bones, 
while those of another have a small frame. The etiological causes of 
obesity, outside of those just named, are numerous, but the chief one 
is overindulgence in food. 

It is not out of place to state exactly what overindulgence in 
food means. Every individual is a law unto himself in regard to 
the amount of food which is ingested and consumed. One often 
sees large, powerful, wiry men, who eat little, stand beside others, 
not so powerful or large, who eat excessively, and who apparently 
do not suffer from indigestion in consequence. Neither of these 
groups becomes excessively fat, because one represents a grate which 
burns its fuel so that there is no waste, while the other resembles a 
grate in which there is always a residue of unburnt coal which is cast 
out with the ashes as effete matter. As different engines of the same 
build require varying amounts of coal, so do different men assimilate 
different amounts of food. No stated amount of food can be set 
down as a man's daily portion until his case is carefully studied, but it 
is important to remember that the quantity of food is generally in 
direct ratio to the ' severity of the toil, and that a man who loiters 
about a club or "takes life easily" often eats more than a day-laborer 
— of far richer foods, too^and wonders why he gets stout. In nearly 
every case of obesity not dependent upon gross disorder of nutrition 
overindulgence in food is the cause. To some this may seem absurd, 
and the patient will say that he eats just enough to keep him from 
feeling empty between meals; but this does not alter the case in the 
least. The proper amount of food for a man is not what his appetite 
or gastric viscus calls for, but what his system needs. To this further 
reference will be made when considering the diet for obesity, found 
below. 

The very presence of fat aids in the deposition of it, for, by acting 
as a non-conducting pad all over the body, it prevents the dissipation 
of heat, and so decreases the combustion of those substances which, 
when not used for the manufacture of heat, are deposited as fat. 
Again, we often find that obese persons take alcohol with their food, 
thereby increasing the fat in their bodies; for, finding that they cannot 
digest all the substances which greediness makes them swallow, they 
take alcohol to stimulate their digestive apparatus to increased efforts 
and assimilation. Further than this, alcohol adds force to the body, 
and preserves the tissues by substituting itself for food in the oxidizing 
processes. 

We find, therefore, that three great causes are active in producing 
corpulence in many cases — namely, heredity, overindulgence in food, 
and lack of exercise, which is one of the means by which overindul- 
gence is produced; i. e., less exercise, less food needed, but often more 
eaten. 



748 DISEASES, 

The treatment of corpulence rests solely upon the conditions named. 
In all instances the diet is the important point for the bestowal of care. 
Reference has already been made to the fact that the needs of the system 
are the criterion by which should be determined the amount of food 
necessary to each case, not the sensations in the stomach. The use of 
coca by the natives of South America enables them to withstand 
hunger and privation, not because it gives tissue to the body, but 
because it paralyzes the sensory nerves in the stomach and relieves 
the sensation of hollowness or weakness which we are accustomed to 
overcome in this country, in the absence of food, by tightening our 
belts. Every one who has undergone severe mental or physical labor 
and missed a regular meal will remember that about the usual hour 
for the meal his sensation of emptiness may amount to nausea and 
distress, but the hour once passed he feels as strong as before until 
by prolonged toil he so exhausts his powers that the system forces 
him to eat, not so much from hunger as from exhaustion. To under- 
stand this clearly, we must recollect that the system keeps its shares 
of force in the same way as a careful speculator keeps his shares of 
stock — namely, one part in active use for speculation, the other half 
for reserve in case of need. In health the stomach begins to "feel 
hungry" as soon as the speculative shares of force are nearly used, 
in order to cause the ingestion of more food and to preserve the " sink- 
ing fund" intact. It becomes evident, therefore, that the mere pres- 
ence of hunger is purely a symptom, not an indication of the absolute 
necessity of food, for, if it were, the consumptive would be notorious 
for his appetite, instead of being noteworthy for his anorexia. 

The food of the patient suffering from obesity is to be cut down 
gradually, and the character of it arranged so that, though its bulk be 
great, its nutritive properties are small. Beef and other meats are 
concentrated foods containing much nourishment in a small bulk, 
while lettuce, spinach, cabbage, and nearly all vegetables, except 
roots or tubers, contain a large amount of fibre useless to the body. 
By the use of a carefully arranged vegetable diet in obesity we cut 
down the actual amount of food absorbed, and by its bulk keep the 
stomach so busy at sifting the nutritious from the non-nutritious 
materials that hunger is not felt, because another meal-time is reached 
almost before the food of the first is assimilated. We find, therefore, 
that the diet for the reduction of corpulence should consist chiefly of 
bulky vegetables, but not too exclusively of any one article or set of 
articles. Heretofore it has been thought that proteids (meats, eggs, 
etc.) should be used to take the place of all hydrocarbons or carbohy- 
drates (fats, starches, and sugars), but this is not physiologically cor- 
rect, as both forms of food are always needed for health, and it has 
been found that proteids may be converted into fats in the body. 

The following bill of fare will be found of service in the treatment of 
obesity. 

Breakfast : One or two cups of coffee or tea, without milk or sugar, 



OBESITY. 749 

but sweetened with a fraction of a grain of saccharin. Three ounces 
of toasted or ordinary white bread or 6 ounces of bran bread. Enough 
butter may be used to make the bread palatable — not more than 1 
ounce. Sliced raw tomatoes with vinegar or cooked tomatoes without 
any sugar or fats. This diet may be varied by the use of salted or 
fresh fish either at breakfast or at dinner. This fish must not be rich 
like salmon or sword-fish, but rather like perch or other small fish. 

Noon meal (dinner): One soup-plate of bouillon, consomme, 
Julienne, or other thin soup, or Mosquera's beef-jelly, followed by one 
piece of the white meat of any form of fowl or a small bird. Some- 
times a small piece, the size of one's hand, of rare beef or mutton, but 
no fat, may be allowed, and this should be accompanied by string- 
beans, celery (stewed or raw) , spinach, kale, cabbage, beans, asparagus, 
leeks, and young onions. Following this, lettuce with vinegar and a 
little olive oil (to make a French dressing), a cup of black coffee or one 
of tea, and a little acid fruit, such as some sour grapes, tamarinds, and 
sour oranges or lemons, may be taken, and followed by a cigar or 
cigarette. 

Supper should consist of one or two soft-boiled eggs, which may also 
be poached, but not fried, a few ounces of bran bread, some salad and 
fruit, and perhaps a glass or two of light, dry (not sweet) wine, if the 
patient is accustomed to its use. 

Before going to bed, to avoid discomfort from a sensation of hunger 
during the night, the patient may take a meal of panada, or he may 
soak Graham or bran crackers or biscuits in water and flavor the mass 
with salt and pepper. 

The reduction of diet is generally best accomplished slowly, and 
should be accompanied by measures devoted to the utilization of the 
fat present for the support of the body. Thus the patient should not 
be too heavily clad, either day or night, should resort to exercise, 
daily becoming more severe, and should not drink freely of water, 
unless sweating is established sufficiently freely to prevent the accumu- 
lation of liquid in vessels and tissues. 

Very often a cold bath will, by its dissipation of heat, cause destruc- 
tion of fat, which will be burnt up in the body in the manufacture of 
heat-units to maintain the temperature ; and if the patient is not too 
anaemic and stands this exposure to cold well, the bath should be 
repeated each day or a Turkish bath used instead. 

The bowels should be kept active by laxative fruits or purges, but 
if liquids taken in drink are not eliminated rapidly, saline purges are 
useful, since, if the bloodvessels are engorged, the circulation in the 
capillaries is slow and a deposit of fat is apt to result. 

Where proper exercise is impossible the rest cure, with massage, 
electricity, passive exertion, and an absolute skimmed-milk diet, may 
be resorted to, particularly in those persons known as "fat amemics," 
who have not enough red corpuscles in their blood to carry sufficient 
oxygen to the tissues to complete oxidation. 



750 DISEASES. 

So far as medication is concerned, the value of thyroid gland in 
some cases is not to be forgotten. (See Thyroid Gland, Part II.) 

PERICARDITIS. 

Inflammation of the pericardial sac requires prompt treatment. If 
the case be sthenic and is seen early, and the heart is overacting, five 
to ten leeches or several small fly blisters should be placed over the 
prsecordium, and at the same time sufficiently large doses of veratrum 
viride or aconite given to depress the circulation, and by dilatation of 
the bloodvessels elsewhere to draw off the blood from the inflamed 
area. An ice-bag placed over the prsecordium not only relieves the 
pain, quiets the circulation, and reduces the temperature, but also acts 
favorably in modifying the severity of the inflammation. 

Where the case passes from the acute stage of inflammation to that 
in which effusion takes place, or if the patient is already depressed by 
illness, the treatment changes at once, and becomes supportive if the 
system shows signs of failure. The friction-sounds of the first stage 
are now lost, and the heart-sounds may be feeble or muffled by reason 
of the effusion present. Digitalis, alcohol, or caffeine may be used if 
the heart shows signs of failure; but when digitalis is used its influence 
should be carefully watched, since the employment of this drug pro- 
duces a very full diastole or dilatation of the ventricles, and these are 
already cramped for space in which to dilate by reason of the exudate 
which has entered the pericardial sac. If the effusion is sufficient to 
endanger life, it should be tapped and aspirated very gradually. Often 
it is best to explore with a long needle attached to a hypodermic syringe 
in order to be sure that there is fluid, but the greatest care must be 
taken that the heart is not wounded. After the skin is punctured a 
dull canula should be pushed into the sac, as a sharp one may wound 
the heart. Some authorities hold that the danger of wounding the 
heart is so great that it is best to make an incision. The best place 
for making the puncture is the fourth or fifth intercostal space, very 
close to the left edge of the sternum. Often a blister over the prse- 
cordium is of service in aiding absorption. Should pus be present, 
free drainage must be established by means of an incision, and it may 
be necessary to excise the sternal end of the fifth rib on the left side. 

PERITONITIS (ACUTE) 

The views of the best minds in the medical profession concerning 
the treatment of peritonitis have changed radically in the last ten 
years, chiefly through the advances made in abdominal surgery and 
bacteriological research. These opportunities for study have shown 
that peritonitis never arises as a strictly primary condition, but is 
due in every case to the infection of the peritoneum by micro-organ- 
isms, benign or malign, which originally are found in the intestines 



PERITONITIS {ACUTE). 751 

or other portions of the abdominal viscera. Even when peritonitis 
follows directly upon injury, the actual cause of the pathological 
process is the escape of micro-organisms through the devitalized wall 
of the intestine, and the severity of the attacks depends in turn upon 
the vital resistance of the patient, the virulence of infection, and the 
rapidity with which a plastic exudate is thrown out to encapsulate 
the inflamed area. 

It is not possible in this article to discuss the facts now known in 
regard to the etiology and pathology of acute peritonitis. Suffice it 
to state that the bacillus coli communis found normally as a benign 
inhabitant of the intestine becomes at once, on entrance into the 
peritoneal cavity, malignant and capable of producing rapidly fatal 
peritonitis. Nor is actual rupture of the bowel or appendix vermi- 
formis necessary for this infection, since it has been shown that this 
germ rapidly migrates through the bowel-wall as soon as it becomes 
inflamed or congested in all its coats. Streptococci and staphylo- 
cocci, finding access to this cavity, also produce violent inflammation. 
It has been found that the peritoneum will destroy many infecting 
germs if its vitality is not impaired, but if it is impaired, even a mild 
infection gives rise to severe inflammation. 

Having learned, then, that acute peritonitis is always secondary to 
some local cause or to some general infection, the first thing for the 
therapeutist to do is to determine what the provoking agent is, in order 
that his treatment may be directed against the cause rather than the 
effect. This cause is now known, in the great majority of cases, to 
be Appendicitis (which see), the inflammatory process being spread 
by infection from this source. In women it is not uncommonly due 
to more or less obscure pelvic disease; or, again, it may arise from 
abscess and other severe diseases of the liver, spleen, pancreas, or 
stomach. Finally, it should never be forgotten that intestinal obstruc- 
tion and perforation are causes of peritonitis. The physician may 
rest assured that if he cannot find the provoking cause, it is his own 
fault, and not decide that the case is purely idiopathic. 

Having found the cause, treatment is of course to be at once insti- 
tuted, and is medical or surgical — more commonly the latter than the 
former, since nearly all the exciting causes of this disease are at 
most only palliated by medicinal treatment, while they can sometimes 
be removed by surgical interference. Fortunately for those who can 
only obtain medicinal treatment, nature does much to aid in producing 
a cure in many cases by limiting the disease through its localization 
by walls of lymph, so that many cases of peritonitis recover without 
active medicinal or surgical care. In the pelvis this localization of 
the process is very apt to take place unless the infection follow child- 
birth, when septic diffuse peritonitis may arise, which is always fatal 
unless surgical assistance is obtainable. 

If the trouble arise in the appendix vermiformis, this condition 
may be treated in its early stages by the means suggested in the article 



752 DISEASES. 

on Appendicitis, but at the very first sign of the spread of the inflamma- 
tion, or of its becoming locally very severe, or of general systemic dis- 
turbance, the surgeon must be called in. In many cases requiring 
operation it is performed too late through the hesitancy of the patient, 
his friends, the physician, or even of the operator himself. If the 
local trouble does not seem to be spreading and the patient's 
general condition is favorable, operation should be postponed until a 
state of quiescence is reached, when the prospects of recovery from 
operative interference are better. If there is reason to believe that an 
abscess has ruptured into the peritoneal cavity, or if perforation of the 
bowel is suspected or shown to be present by severe general symptoms 
of widespread peritoneal involvement, operation should be resorted to 
at once. 

In deciding the question, however, as to whether a case of peritonitis 
requires surgical interference, the physician at the present time is in an 
unfortunate position. There can be no doubt that there are many 
records in medicine which prove most conclusively that lives have been 
saved through operative interference which would have been undoubt- 
edly lost had the surgeon not come to the rescue. On the other hand, 
there are cases in which a fatal result has followed an operation, and in 
which the physician has bitterly reproached himself that he consented 
to surgical interference, for as he looked back over the case he per- 
ceived that the operation distinctly aided in causing the loss of life. At 
the present time each case must be decided upon its individual merits, 
and the physician or surgeon in giving advice to the family in regard 
to a well-developed case of peritonitis should always be careful to let 
them understand distinctly that the condition of the patient is most 
alarming, and the chances of life poor whether the treatment be medi- 
cal or surgical, since in many instances neither form of remedial 
measure can possibly produce good results. In other words, the 
relatives should clearly be made to understand that whether medicinal 
measures or surgical procedures are resorted to, the patient has only 
a fighting chance. 

The following case illustrates the value of surgical interference in 
peritonitis : 

M was taken ill at twelve midnight, with violent pain in the 

belly, and was seen by the writer the following evening at eight o'clock. 
At this time all the physical signs of a widely diffused peritonitis were 
present. The belly was hard and board-like, the pulse was exceed- 
ingly rapid, the respirations 56, and there was great pain. Care- 
ful physical examination of the belly and a study of the patient's 
history failed to reveal any cause near or remote for the attack, he 
having been in perfect health up to the time at which the pain began. 
After consultation with an eminent surgeon it was decided that his 
condition was so pressing that death under medicinal treatment was 
assured, and that, while operative interference offered but a faint 
chance of success, it was the only measure which could be resorted to. 



PERITONITIS {ACUTE). 753 

Accordingly, at twelve o'clock that night, just twenty-four hours after 
the pain began, the patient was operated upon, the incision being 
made in the median line for the purpose of exploring the belly, with 
the hope that an exciting cause for the attack might be found. On 
opening the belly it was found that acute intestinal obstruction had 
taken place through the bowel being twisted over an old inflammatory 
band. After this obstruction had been reduced the appendix was 
examined, and found to be in a condition of acute inflammation, and 
for this reason it was removed. It was noted that the peritoneal 
surfaces of the intestines and of the abdominal wall were intensely 
hyperaemic and red, and lacking in their normal appearance. The 
operation lasted an hour and a half, and the patient recovered after a 
desperate struggle for life which lasted for weeks, during which time 
his attendants several times gave up all hope of his recovery. Had no 
operation been permitted, death would certainly have resulted from 
the intestinal obstruction if not from the appendicitis, and had the 
median incision not been made, but the appendix alone sought for by 
a lateral incision, the obstruction would have been overlooked, and 
the death recorded as one due to general peritonitis following appendi- 
citis for which an operation had been performed unsuccessfully. 

This work is not the place for the consideration of the surgical 
procedures to be followed, but it may be stated that in septic peritonitis 
in all cases it is a question of operation with probable death, or no 
operation with certain death. In obscure cases of general peritonitis, 
where the cause of the disease cannot be detected by ordinary methods 
of diagnosis, the writer believes that exploratory incision should be 
done, and after the cause is removed the belly-cavity should be well 
washed out with hot normal saline solution, and a drainage-tube or 
gauze left in for at least twenty-four hours. 

Aside from the surgical treatment, which is an absolute essential in 
many cases of peritonitis, we have at hand medicinal methods which 
are of some value early in the attack and where operation is refused 
or considered inadvisable. The first of these is the use of opium, 
given until the pain is partly decreased and the respirations decreased 
to 12 or 14 per minute. The patient should never be so narco- 
tized as to have no pain on abdominal palpation or be unable to 
answer questions. On the other hand, it should be remembered that 
cases of peritonitis bear large doses of opium without effect. The 
dose should be pushed till the desired effect is obtained, and not be 
measured in grains. Cases are on record in which many hundred 
grains of opium have been given in a few days, with recovery as a 
result. (For the proper use of opium see Appendicitis.) 

An ice-bag or a turpentine stupe may be put over the area originat- 
ing the trouble. If the case is very sthenic, leeches may be used on the 
belly, but this is not advisable in most cases, as the patient may later 
need the blood to preserve his strength. Should vomiting be a press- 
ing symptom, it is best controlled by the use of 2 grains of acetanilid 

48 



756 DISEASES, 

very uncomfortable. They have been supplanted almost entirely by 
the cotton jacket, which is much better. It consists of one or two 
thicknesses of carded cotton basted inside a thin undershirt, as fur is 
placed in a fur-lined coat. On the outside of the shirt oiled silk should 
be basted. By using this we envelop the chest in a warm poultice, 
because the heat of the body keeps the cotton at the proper tempera- 
ture, while the oiled silk, by preventing evaporation of the moisture 
exhaled from the skin, soon causes the cotton to become moist as well 

Fig. 112. 



1\ #c 



I 



Showing the overlapping of the adhesive strips in strapping the chest for painful pleurisy. 
The strips extend too far to the patient's right. 

as warm. Even the cotton jacket is losing its popularity, as the fever 
of the patient makes a hot jacket almost unbearable and it does 
little real good. Further, its removal is very apt to result in exposure 
to cold. The author never uses either of these dressings. 

When the pleurisy has fully developed, other lines of treatment are 
needed. The cardiac sedatives should be stopped as soon as the quiet- 
ing of the circulation has been accomplished. If the pulse becomes 
weak and the system is depressed, stimulants in the form of alcohol or 
digitalis are needed, and special care must be devoted to the condition 
of the exudate in the pleural space. 



PLEURITIS, OR PLEURISY. 



757 



The physical signs at this time consist in flatness on percussion 
over the lower portions of the chest, which area of flatness generally 
varies with the change in the position of the patient from the erect 
to the recumbent position, unless the effusion is sacculated. Blow- 
ing or bronchial breathing at the apex of the lung, when this organ 
is compressed upward by the fluid beneath it, is often heard. If the 
effusion is on the right side, the apex beat of the heart is apt to be 
displaced to the left. If it is on the left side, there is obliteration of 
Traube's semilunar space, which is a spot at about the level of the 
sixth and seventh ribs anteriorly below the nipple, where there is 
usually a tympanitic note on percussion. 

If the effusion is sufficiently large to cause marked dyspnoea 
or reaches to the third interspace anteriorly, it should be removed 
by aspiration. When the effusion is not causing dyspnoea, or other 
evil symptoms by reason of pressure, the physician should allow 
sufficient time for recovery to occur; as, for example, a week or ten 



Fig. 113. 




Arrangement of bottles for promoting lung expansion. 



days, during which interval the system will in many cases remove 
the fluid by natural processes of absorption. If after this time has 
elapsed the quantity of fluid remains unchanged, it is wise to give 
salicylic acid in the dose of 1 to 2 drachms (4.0-8.0) a day, or saline 
purges given in the early morning in concentrated form; and finally, 
if the fluid is not taken up by the vessels after a dose of jalap or 
elaterium is used, resort must be had to aspiration of the liquid. 
These purges ought never to be employed so freely as to weaken the 
patient, but in most cases this cannot be avoided if the purgative is 
active enough to be effective in withdrawing liquid from the body- 
cavities. In his own practice the author rarely uses these drugs, but 
resorts at once to aspiration. 

In cases in which it is desired to attempt the removal of a pleural 
effusion by the use of .purgatives and diuretics, and it is doubtful if 
absorption can go on through the pleura, we may inject 5 grains (0.3) 



758 DISEASES. 

of methylene blue into the affected pleural cavity, give the purgative, 
and examine the urine for the blue. If it is eliminated, absorption 
is possible; if not, the removal of the fluid by the aid of purgatives is 
probably impossible. 

In order to cause proper expansion of the lung after convalescence 
is begun, chest exercises should be used (see Part III.) and wash- 
bottles may be employed, as are shown in Fig. 113. 

There is no danger in aspiration if it is properly performed. The 
best place to insert the needle is the sixth or seventh interspace in the 
middle axillary line. Care should be taken that the needle is aseptic; 
that the skin at the point of puncture is well cleansed; and that the 
exhaust-pump is working well. All the liquid should not be withdrawn 
at one sitting. Often the withdrawal of a portion of it will result in 
the natural absorption of the quantity which is allowed to remain in 
the chest. 

During this stage of effusion blisters have been largely used to aid 
absorption of the fluid which is present, but they are not of great 
service. When used they should be applied in the form known as fly- 
ing blisters. (See Cantharides, Part II.) It is to be remembered that 
blisters are, as a rule, contraindicated in the case of children, because of 
the pain and irritation they produce. If a pleural effusion in the chest 
of a child is not absorbed by natural processes, it is best to aspirate it. 

If the fluid is purulent, it must be removed by making an intercostal 
incision and draining the abscess cavity, although if the displacement 
of the heart is great we should first aspirate to relieve pressure and 
operate afterward. 

PLEURODYNIA. 

This condition, being one of intercostal neuralgia, should be treated 
according to the directions given under the headings of Neuralgia and 
Counterirritation. 

PNEUMONIA. 

Pneumonia is a term loosely applied to two very different forms of 
disease — namely, that acute infectious process due to an infection by 
micrococcus lanceolatus and called croupous pneumonia; and that 
form following, as a rule, some other disease which has exhausted the 
patient's strength and due in some cases to various forms of infection, 
namely, catarrhal pneumonia. These two distinct diseases have been 
confused by the common term pneumonia, and yet are very different 
conditions as to their pathology and treatment. 

Croupous Pneumonia. 

The treatment can be divided into that devoted to the stage of 
onset, the stage of consolidation, and the stage of absorption of 
the exudate and convalescence; and it will be governed by the state 
of the patient's pulse, the sounds of his heart, and his general 



PNEUMONIA. 759 

condition as to strength, as well as the degree of respiratory embar- 
rassment which is present. There can be no routine treatment of 
croupous pneumonia; each case must be a law unto itself, and there is 
no such thing as the depletant treatment to be advocated on the one 
hand, nor the stimulant treatment to be lauded on the other. Further 
than this, it must be remembered that as croupous pneumonia is an 
acute infectious disease the patient may die not from pulmonary con- 
solidation nor cardiac distention, but from the malignancy of the infec- 
tion. One man with an entire lung consolidated may have slight 
evidences of general infection or toxaemia; another with a small area 
of lung involved may be overwhelmed by toxaemia within a few hours. 
For this and other reasons all cases of croupous pneumonia may be 
divided into three groups — those that are doomed to death by the 
malignancy of the infection, those that are but slightly ill by reason 
of mild infection, and those which are between these two extremes of 
severity and need careful medical aid to accomplish recovery. The 
first class die do what we will, the second class get well almost without 
help, the third need all the help possible to survive. It is to this last 
class that our treatment must be chiefly directed. 

The fact must not be lost sight of that croupous pneumonia is often 
a terminal infection superimposed upon nephritis or some other 
malady. The primary disease must, therefore, be considered in all 
plans of treatment. 

In the very earliest stages of the disease occurring in a healthy, 
sthenic individual who has been seized with a chill followed by fever 
and a bounding pulse, with marked anxiety and nervous excitement, 
it is often proper to bleed freely from a vein in the arm to the extent 
of a pint (see Part III.), or in its stead to use veratrum or aconite to 
relax the systemic bloodvessels and " bleed him into his own vessels " 
by making it easier for the blood to pass into the general arterial 
system than into the lung which is inflamed. These sedative drugs also 
quiet the excited heart and prevent it from pumping so much blood 
into the engorged lung. A hot foot-bath at this time will also tend to 
relieve thoracic congestion. If veratrum or aconite is used, it should 
be given in 5 minim doses of the tincture every half-hour till five or 
ten doses have been used or until the patient's pulse becomes quiet 
and his skin moist. Veratrum is the best drug of the two for adults 
If severe pain in the chest is present, it is to be relieved by moderate 
doses of morphine or Dover's powder. This treatment is devoted to an 
attempt to limit the degree of inflammatory action as far as possible. 
It may be aided, if it is thought wise, by wet cups over the engorged lung. 

The depressant treatment of croupous pneumonia is, however, lim- 
ited in its application to the very beginning of the malady and to those 
persons who have a bounding circulation. It is absolutely contraindi- 
cated after consolidation has taken place or if the patient is feeble. 
Because of the fact that its usefulness is confined to this early stage, it 
cannot be employed in many cases because the physician is not called 



760 DISEASES. 

till after this stage has passed by. I repeat, that its use in a case with a 
feeble pulse or in one who is adynamic or feeble is absolutely contra- 
indicated. Furthermore, it is not to be used if any primary malady, 
such as nephritis, is present, as this renders the case asthenic from the 
onset. 

In the majority of cases the physician is called after consolidation 
has occurred, and he must now be a watchman all the time and a 
therapeutist only when treatment is actually needed. Every patient 
who is suffering from pneumonia does not need active treatment. A 
certain number of cases get well without treatment, and do so sooner 
than if meddlesome therapeutics hinders them. The treatment usually 
necessary is to combat fever if it becomes excessive, to support the 
heart if it seems feeble or engorged, to keep the kidneys in a state of 
active secretion, and to see that constipation is relieved. 

In the treatment of the fever the physician should remember that it 
is not to be regarded as a dangerous symptom unless it rises to 103° F. 
and remains at this point for some hours, for in a febrile disease running 
a short course fever is not only not harmful, but there is also reason to 
believe that when present to a moderate degree it is actually beneficial. 1 
When the fever does rise to a point above 103° F. it should be reduced 
by sponging with cool water, active friction being used at the same time. 
(See Cold, in Part III.) There is absolutely no danger of the patient 
"taking cold," although this is generally doubted by the laity. If 
the fever has a tendency to be excessive and if the heart's action is 
tumultuous, an ice-bag may be placed over the heart, and this will be 
particularly useful if, as is often the case, there is a tendency to pericar- 
ditis. If it is desired to apply cold over a greater area of the chest 
than the pryecordium, cold compresses may be employed, but they pos- 
sess the disadvantage of being wet applications, do what we will to 
protect the bedding. The cold plunge bath is always badly borne in 
croupous pneumonia. (See Cold, in Part III.) 

The use of antipyretic drugs is not good practice. They tend to 
depress the heart, to relax the bloodvessels, and apparently render the 
patient more susceptible to his infection. 

For the support of the heart several circulatory stimulants may be 
employed. If the patient is feeble with lack of vitality and relaxa- 
tion of his vessels, then alcohol in the form of a good whiskey or 
brandy given in water after food every three or four hours in the dose 
of from half an ounce to an ounce is useful. Sometimes more than 
this must be given, particularly if the patient has been accustomed to 
the use of the stimulant. In other cases none is needed. 

For the laboring heart with almost empty arteries no drug com- 
pares with digitalis; and if the skin is moist or the bloodvessels 
relaxed, so that the pulse is gaseous, then belladonna should be 
combined with it. The writer usually gives 8 minims (0.50) of a 

1 See article on " The Role of Fever in the Modification of Disease," in the Therapeutic 
Gazette for February, 1896. 



PNEUMONIA. 761 

physiologically tested tincture of digitalis every eight hours, with 8 
minims (0.5) of the tincture of belladonna every four hours. (See 
Digitalis and Belladonna.) If necessary, both of these drugs may 
be given in larger dose, but usually these doses are sufficient. If the 
fever is very high, the digitalis will often have to be supplanted by 
alcoholic stimulants or strychnine for a few doses. The question as 
to whether the patient's pulse is of the proper strength is one of impor- 
tance : very often the quiet pulse of a patient lying in bed will be taken 
by the anxious attendant as an evidence of true cardiac feebleness, 
when if the physician feels his own pulse he will be surprised to find it 
no stronger than that of his patient. A feeble apex beat, a feeble second 
sound at the second right costal cartilage (aortic valve), and an accent- 
uated second sound at the second left costal cartilage (pulmonary 
valve) will reveal the fact that active stimulation is needed, for the 
weak apex beat and the soft second (aortic) sound show that the heart 
is feeble and the arterial walls relaxed, and this means a low arterial 
pressure. Further, the accentuated second sound on the right side 
indicates pulmonary congestion and a tendency to failure of the right 
side of the heart from obstruction to the flow of blood in the lungs. 

Should the action of the heart become labored, the jugular veins 
distended and pulsating, and the radial pulse weak, while the face is 
cyanotic, then free venesection (Part III.) is to be practised. It will 
often save an apparently desperate case. Digitalis in the presence of 
this condition is not rapid enough in its effects. Strychnine should be 
given in full dose hypodermically, ■£$ to ■£$ of a grain (0.003-0.006), 
and with it, if the skin is moist or sweating, y^-g of a grain of atropine 
(0.0004), and both these drugs should be repeated in an hour if needed. 
At the same time it is well to give \ drachm (2.0) of aromatic spirit of 
ammonia every two hours in cold water or 1 drachm (4.0) of Hoffmann's 
anodyne in cold water every hour. Oxygen inhalations may be used 
at this time with benefit, particularly if cyanosis is marked. (See 
Oxygen.) 

If the patient be one advanced in years, with thickened arteries and 
a high arterial tension which causes the heart's action to be labored, 
nitroglycerin is to be employed. 

Should crisis come on at this time, active supportant treatment, such 
as that just described, will be needed. Many patients die in crisis for 
the want of active stimulation. 

Nervous excitement with insomnia, if excessive, should be combated 
by small doses, \ to \ grain (0.008-0.015), of morphine, given in the 
early evening by hypodermic injection. 

The secretion of the kidneys is best maintained by the use of some 
alkaline diuretic, such as sweet spirit of nitre and citrate of potassium, 
and if necessary a little gin may be given to support the heart and aid 
in maintaining renal activity. 

Having detailed this treatment of the second stage, that for the 
third stage is to be considered. 



— 



760 DISEASES. 

till after this stage has passed by. I repeat, that its use in a case with a 
feeble pulse or in one who is adynamic or feeble is absolutely contra- 
indicated. Furthermore, it is not to be used if any primary malady, 
such as nephritis, is present, as this renders the case asthenic from the 
onset. 

In the majority of cases the physician is called after consolidation 
has occurred, and he must now be a watchman all the time and a 
therapeutist only when treatment is actually needed. Every patient 
who is suffering from pneumonia does not need active treatment. A 
certain number of cases get well without treatment, and do so sooner 
than if meddlesome therapeutics hinders them. The treatment usually 
necessary is to combat fever if it becomes excessive, to support the 
heart if it seems feeble or engorged, to keep the kidneys in a state of 
active secretion, and to see that constipation is relieved. 

In the treatment of the fever the physician should remember that it 
is not to be regarded as a dangerous symptom unless it rises to 103° F. 
and remains at this point for some hours, for in a febrile disease running 
a short course fever is not only not harmful, but there is also reason to 
believe that when present to a moderate degree it is actually beneficial. 1 
When the fever does rise to a point above 103° F. it should be reduced 
by sponging with cool water, active friction being used at the same time. 
(See Cold, in Part III.) There is absolutely no danger of the patient 
"taking cold," although this is generally doubted by the laity. If 
the fever has a tendency to be excessive and if the heart's action is 
tumultuous, an ice-bag may be placed over the heart, and this will be 
particularly useful if, as is often the case, there is a tendency to pericar- 
ditis. If it is desired to apply cold over a greater area of the chest 
than the pnecordium, cold compresses may be employed, but they pos- 
sess the disadvantage of being wet applications, do what we will to 
protect the bedding. The cold plunge bath is always badly borne in 
croupous pneumonia. (See Cold, in Part III.) 

The use of antipyretic drugs is not good practice. They tend to 
depress the heart, to relax the bloodvessels, and apparently render the 
patient more susceptible to his infection. 

For the support of the heart several circulatory stimulants may be 
employed. If the patient is feeble with lack of vitality and relaxa- 
tion of his vessels, then alcohol in the form of a good whiskey or 
brandy given in water after food every three or four hours in the dose 
of from half an ounce to an ounce is useful. Sometimes more than 
this must be given, particularly if the patient has been accustomed to 
the use of the stimulant. In other cases none is needed. 

For the laboring heart with almost empty arteries no drug com- 
pares with digitalis; and if the skin is moist or the bloodvessels 
relaxed, so that the pulse is gaseous, then belladonna should be 
combined with it. The writer usually gives 8 minims (0.50) of a 

1 See article on " The Role of Fever in the Modification of Disease," in the Therapeutic 
Gazette for February, 1896. 



PNEUMONIA. 761 

physiologically tested tincture of digitalis every eight hours, with 8 
minims (0.5) of the tincture of belladonna every four hours. (See 
Digitalis and Belladonna.) If necessary, both of these drugs may 
be given in larger dose, but usually these doses are sufficient. If the 
fever is very high, the digitalis will often have to be supplanted by 
alcoholic stimulants or strychnine for a few doses. The question as 
to whether the patient's pulse is of the proper strength is one of impor- 
tance : very often the quiet pulse of a patient lying in bed will be taken 
by the anxious attendant as an evidence of true cardiac feebleness, 
when if the physician feels his own pulse he will be surprised to find it 
no stronger than that of his patient. A feeble apex beat, a feeble second 
sound at the second right costal cartilage (aortic valve), and an accent- 
uated second sound at the second left costal cartilage (pulmonary 
valve) will reveal the fact that active stimulation is needed, for the 
weak apex beat and the soft second (aortic) sound show that the heart 
is feeble and the arterial walls relaxed, and this means a low arterial 
pressure. Further, the accentuated second sound on the right side 
indicates pulmonary congestion and a tendency to failure of the right 
side of the heart from obstruction to the flow of blood in the lungs. 

Should the action of the heart become labored, the jugular veins 
distended and pulsating, and the radial pulse weak, while the face is 
cyanotic, then free venesection (Part III.) is to be practised. It will 
often save an apparently desperate case. Digitalis in the presence of 
this condition is not rapid enough in its effects. Strychnine should be 
given in full dose hypodermically, -£-$ to T ^ of a grain (0.003-0.006), 
and with it, if the skin is moist or sweating, t i=-q- of a grain of atropine 
(0.0004), and both these drugs should be repeated in an hour if needed. 
At the same time it is well to give \ drachm (2.0) of aromatic spirit of 
ammonia every two hours in cold water or 1 drachm (4.0) of Hoffmann's 
anodyne in cold water every hour. Oxygen inhalations may be used 
at this time with benefit, particularly if cyanosis is marked. (See 
Oxygen.) 

If the patient be one advanced in years, with thickened arteries and 
a high arterial tension which causes the heart's action to be labored, 
nitroglycerin is to be employed. 

Should crisis come on at this time, active supportant treatment, such 
as that just described, will be needed. Many patients die in crisis for 
the want of active stimulation. 

Nervous excitement with insomnia, if excessive, should be combated 
by small doses, \ to \ grain (0.008-0.015), of morphine, given in the 
early evening by hypodermic injection. 

The secretion of the kidneys is best maintained by the use of some 
alkaline diuretic, such as sweet spirit of nitre and citrate of potassium, 
and if necessary a little gin may be given to support the heart and aid 
in maintaining renal activity. 

Having detailed this treatment of the second stage, that for the 
third stage is to be considered. 



762 DISEASES. 

It must be remembered that in most individuals the process of 
repair is carried out best if the efforts of nature are not meddled with. 
When resolution is delayed, there is always a possibility of the condi- 
tion being tubercular, and this should make the physician cautious in 
the use of alteratives, such as the iodides, for if tuberculosis be the 
cause of the condition such treatment may cause rapid breaking down 
of the lung. 

First and foremost for the relief of any associated bronchitis stands 
the chloride of ammonium, a drug whose elimination takes place largely 
through the lungs, and which acts most happily in aiding in the loosen- 
ing of the cough and secretions. Its only disadvantage is its salty 
taste, which in many cases renders it disagreeable to the patient, 
while its irritant properties may disorder the action of the stomach, 
although if this organ is depressed and atonic this drug often improves 
its condition. This drug may be given in compressed pills, or, what 
is far better, in such a mixture as here follows: 

1$ — Ammonii chloridi ,^ij (8.0). 

Fluidext. glvcyrrhizae f.^ij (8.0). 

Aquae dest fgiij (90.0).— M. 

S. — Teaspoonful (4.0) in water every four hours during the day. 

If the cough be in excess of the expectoration — that is, if the cough 
often fails to bring up phlegm and is due to tickling or irritation — it 
may be relieved by the addition of a little morphine to this mixture, 
as follows: 

1$ — Morphinae sulph gr. j vel gr. ij (0.06-0.12). 

Ammonii chloridi gij (8.0). 

Fluidext. glycyrrhizse f giv (16.0). 

Aquae dest. . ...... . f^vj (180.0).— M. 

S. — Dessertspoonful (8.0) every four hours in water 

If much more morphine than this is used, it will tend to stop secretion. 

When the chloride of ammonium fails to act favorably, the car- 
bonate may be called into use for its local and circulatory action, and, 
in addition, the bromide of ammonium may be employed to allay the 
cough if morphine cannot be used. The following prescription is 
valuable : 

^ — Ammonii chloridi . . .. . . . • 5j (4:0). 

Ammonii bromidi ....... 5j (4.0). 

Ammonii carbonat 5j (4.0). 

Fluidext. glycyrrhizse f^iij (12.0). 

Aquae dest fgvj (180.0).— M. 

S.— Dessertspoonful (8.0) every four hours in water. 

In other cases heroin may be given in the dose of ^ grain (0.005) 
every eight hours to control excessive cough. 

(For other remedies for this stage see Bronchitis.) 
It must be borne in mind that the effect of expectorant drugs upon 
the pneumonic process itself is very slight, and that they are not to be 
given unless bronchial secretion is present in excess. 



PRURITUS. 763 

Nutritious broths, milk, and, if necessary, predigested foods, should 
be given with even greater regularity than medicine would be given, 
from the beginning to the end of the attack. 

Catarrhal Pneumonia. 

The main difference in the treatment of Catarrhal Pneumonia in 
distinction from the treatment of croupous pneumonia lies in the fact 
that first, last, and all the time the treatment is to be stimulant in its 
character if any treatment other than rest in bed is resorted to. Catar- 
rhal pneumonia usually arises out of a severe bronchitis or is superim- 
posed upon some exhausting disease which has sapped the vitality. 
Toward its close expectorants are even more useful than in croupous 
pneumonia, and every care should be taken that the catarrhal process 
does not pass by insidious degrees into a hidden tuberculosis. 
Tubercular infection should be suspected in all cases in which recovery 
is abnormally slow. 

PRURITUS. 

Itching of the skin or mucous membranes about the openings of 
the body is a very common state, and while it may be dependent upon 
local causes, such as hemorrhoids in the case of pruritus ani, it more 
commonly is due to some systemic condition, such as debility, diabetes, 
gout, or renal disease, or other similar causes. The treatment con- 
sists, first, in the removal of the cause, and, next, in the local treatment 
of the condition. There is generally no redness or eruption, except 
that due to scratching. 

Internally, arsenic, quinine, bitter tonics, cod-liver oil, alkaline 
diuretics, or mineral waters are useful in debilitated cases, and an 
avoidance of condiments, such as mustard or pepper, is needful if 
the disease affects the orifice of the urethra or vagina. 

The local treatment of pruritus consists in the use of lotions, salves, 
or ointments made up of various constituents, a number of which are 
capable of acting as local anaesthetics. Very often bathing the parts 
with 1 drachm of bicarbonate of sodium or of borax to a pint of cold 
water gives relief temporarily, or the following formulae will be of 
service : 

3— Phenolis f gj velf 3 ij (4.0-8.0). 

Aquse dest q. s. ad Oj (480 c.c). — M. 

S. — Apply as a lotion several times a day. 



Or, 



1$ — Liquor, carbon, detergen. 1 . . . f ^ij (8.0). 

Aquae dest q. s. ad Oj (480 c.c.).— M. 

S. — Apply as a lotion. 



Or an ointment made as follows is serviceable: 

If- Phenolis gtt.vvelxx (0.3-1.3). 

Adipis benzoinati §j (30.0). 

Petrolati 3J (4.0).— M. 

S. — Apply as an ointment. 

1 For method of preparing this liquor see article on Eczema. 



764 DISEASES. 

In other cases 10 to 20 minims (0.60-1.3) of chloroform may be 
used in place of the phenol. 

Cocaine may be painted over the parts, but it should rarely be used 
in ointment, as fats prevent its acting effectively. It should also be 
remembered that the anal and vaginal mucous membranes are so 
thick that strong solutions of cocaine are necessary to produce anaesthe- 
sia, and that the effects of cocaine are only temporary. Cocaine is 
useless when applied to the skin. Where the itching is very obstinate 
the parts may be painted with a solution of nitrate of silver of the 
strength of 20 grains to the ounce (1.3-30.0) of water, cocaine having 
been previously applied to relieve the pain of the application. (See 
article on Cold.) My colleague, Brinton, has highly recommended 
powdered teucrium scordium in the dose of 20 grains (1.3) three 
times a day for itching hemorrhoids. 

Allingham has used with advantage a piece of ivory shaped like a 
rubber nipple and provided with a circular shield. This is slipped 
into the bowel at night and serves to keep the surfaces apart. 

In cases of general pruritus baths are often of great service. They 
may consist in plain hot-water baths or Turkish baths. In other 
instances, to each bath of 30 gallons may be added \ pound of bicar- 
bonate of sodium, or 1 to 4 ounces (30.0-120.0) of borax may be used. 
When the skin is very irritated starch, 1 pound (480), or bran, 2 
pounds (960), may be added to the bath. Sometimes linseed-meal 
baths may be used. The meal is placed in hot water until the gluti- 
nous matter is set free, when it is added to the bath. One or two 
pounds (480-960) are used. In very persistent cases the patient may 
actually eat and sleep in the bath with advantage. 

PUERPERAL DISEASES. 

The diseases of the puerperium may be divided into two broad 
classes — infectious and non-infectious. The first class should be 
further subdivided into (1) those infectious diseases in which the 
point of infection has been somewhere along the parturient tract, and 
(2) those in which the infecting poison has entered the body by some 
other channel. Under subheading 1 come all those disease con- 
ditions grouped together under the very inadequate generic terms 
"puerperal fever," "puerperal septicaemia/' "puerperal infection," and 
the like, none of which truly expresses the condition. If it is neces- 
sary in medical nomenclature to have a single term which shall denote 
infection of the genitalia after delivery, a word should be coined strictly 
limited in sense to mean the pathological conditions which result from 
the activity of pathogenic microbes along the whole genital tract. 
This classification is necessary for a clear and systematic description 
of the treatment of diseases in the puerperal state. 

The Treatment of Infection along the Genital Tract after Labor. — A 
common form of infection along the genital tract after labor is a tox- 



PUERPERAL DISEASES. 765 

semia from the infection and decomposition of membranes, fragments 
of placenta, or blood within the uterus. Therefore, in any case after 
labor in which there is fever that cannot be explained by some evident 
cause independent of the genitalia, it is safe to assume that the uterine 
cavity is the seat of pathogenic micro-organisms. The indications are 
plain: to destroy the microbes, to stop the manufacture of their toxin, 
to remove putrescible material, and to prevent an invasion of the 
system. 

The writer's routine application of this principle in practice is as 
follows: If the temperature after delivery remains over 101° F. for 
twenty-four hours without evident cause independent of the genitalia, 
he washes out the uterine cavity with at least 1 quart (960) either 
of bichloride of mercury solution, 1 : 2000, or a mixture of alcohol, 8 
ounces, water 8 ounces, and tincture of iodine 1 drachm. The former 
is more convenient in private practice, because the tablets of corrosive 
sublimate can be easily carried about in one's instrument-bag. To 
insure the entrance of the antiseptic fluid to the fundus and its free 
exit from the cervical canal an intra-uterine catheter is desirable. Of 
all those upon the market, the best is that known as Fritsch's modifica- 
tion of Bozeman's catheter. If, however, the cervical canal is patu- 
lous, as it usually is after labor, a hard-rubber catheter attached to a 
Davidson or fountain syringe answers the purpose perfectly. 

In many cases this treatment brings the temperature down to normal 
within twenty-four hours. If fever does not appear within this time 
or perhaps rises even higher, the second indication must be met. The 
infected albuminous substances within the uterine cavity, usually 
necrotic endometrium, must be removed in order to deprive the micro- 
organisms of their feeding-ground. This is best accomplished by the 
use of the curette and the placental forceps, care being taken in the 
employment of the former instrument to guard the uterine wall itself 
from the slightest injury; for not only can the uterine muscle be per- 
forated by a curette in clumsy hands, but slight wounds of the uterine 
wall with this instrument may be enough to inoculate the general sys- 
tem with the germs whose activity has been before confined to the 
uterine cavity, by penetrating the layer of granulation cells under the 
endometrium. 

The writer's manner of employing this plan of treatment after labor 
is as follows: 

The anterior lip of the cervix is seized with a double tenaculum 
and pulled gently downward; a cleansing uterine douche is then 
given in order to disinfect the field of operation; next a broad, dull 
curette is inserted to the fundus, and the whole interior of the uterus 
is carefully gone over with the instrument, first the fundus and then 
each of the four sides ; then the curette is turned with the scraping 
surface upward and withdrawn from the cervical canal, a finger in the 
vagina meeting its tip as it emerges in order to help extract any sub- 
stances which may be caught by and entangled in it. 



766 DISEASES. 

Next the placental forceps is inserted, and an effort made to grasp 
any material lying loose within the cavity or still attached to the uterine 
walls. It is usually best to repeat each of these manoeuvres several 
times until nothing more can be brought away except a little clear 
blood. 

Then the uterine cavity is again thoroughly washed out. Occasion- 
ally it is necessary to repeat the irrigation, but rarely the curetting, 
for several successive days. If this treatment should prove unsuccess- 
ful and the temperature remain elevated in spite of irrigation and 
the use of the curette and placental forceps, one must assume either 
that general systemic infection has occurred, or at least that an inflam- 
matory action has begun in the uterine walls or within the tubes. 
One of the signs of systemic invasion is the appearance of peritonitis. 
In such a case the only treatment is to support the body-cells in the 
combat which they must wage with the invading micro-organisms. 
This is best accomplished by the administration of as large a quantity 
of nutriment as the patient can stand without rebellion of the stomach 
or bowels, and the exhibition of a large quantity of alcoholic stimulant. 
Cases of this sort not infrequently require more than a pint of whiskey 
or brandy in the twenty-four hours. Occasionally measures are 
required to reduce an excessive elevation of the temperature, but 
this is best avoided as long as possible, for antipyretic treatment is 
usually depressing and ill suited to the patient's adynamic condi- 
tion. 

The use of antistreptococcic serum, nuclein, and injections of normal 
salt solution are important adjuvants to the treatment which should 
not be neglected in a serious case. With this plan of treatment about 
three-fourths of the cases of general septic infection after labor will 
recover. There may be some in which metastasis to important organs 
occurs so early as to render all treatment of no avail. There will be 
others in which the peritoneum is early infected, and in which the 
septic peritonitis develops rapidly and to an extensive degree. It is 
in such cases that coeliotomy and evacuation of the septic matter, 
usually pus, within the peritoneum will occasionally save life. The 
physician must guard himself, however, from operating too early and 
unnecessarily. After operation, drainage of the peritoneal cavity is an 
essential feature of the treatment, even although the evidence of sup- 
puration within the cavity is slight. The writer has in mind a case in 
which an operation was performed ten days post-partum for septic 
peritonitis: a very small quantity of purulent lymph was found upon 
one ovary, which was greatly enlarged and contained a small quantity 
of seropus. The ovary was removed and the abdomen closed with- 
out drainage, as there was no other evidence of suppuration within it. 
Thirty-six hours later the patient died, and the peritoneal cavity was 
found filled with pus which had accumulated in that short space of 
time. In the early stages of the peritoneal infection, if the subject is 
vigorous, not exhausted by a prolonged labor or other depressing 



PUERPERAL DISEASES. 767 

causes, the administration of saline purgatives in concentrated solution 
often effects brilliant results. 

The writer's custom is to give a dessertspoonful of a concentrated 
solution of Epsom salt every fifteen minutes until free evacuation of 
the bowels is secured. He has seen the temperature reduced by this 
plan of treatment from 104° F. to normal in the course of twelve hours, 
and with the reduction of temperature all the symptoms of peritonitis, 
which were well marked, entirely disappeared. 

In the treatment of microbic activity along the parturient tract after 
labor it should never be forgotten that the point by which the microbes 
invade the system may be anywhere from the fundus of the uterus to 
the parturient outlet; therefore the practitioner should never neglect 
to examine carefully all the lower parturient tract, in order to detect, if 
possible, an ulcerated surface covered by diphtheritic membrane, 
which if overlooked might be the entrance-point for a fatal infection. 
These unhealthy surfaces are best detected by the use of a cylindrical 
speculum of clouded glass introduced so that the cervix appears within 
its inner end, and then withdrawn, so that the vaginal mucous mem- 
brane as it prolapses into the end of the speculum may be examined, 
and treated if necessary throughout its whole extent. If an unhealthy, 
ulcerated wound is thus discovered, the writer's practice is to apply to 
it a solution of nitrate of silver 40 or 60 grains to the ounce (2.60-4.0 : 
30). In the vast majority of cases this application will promote an 
exfoliation of the unhealthy membrane and the appearance of healthy 
granulation tissue within a few days. 

It may, in some cases, be necessary to employ a stronger applica- 
tion, as the solution of chloride of zinc, but the writer has not been 
driven to its use. The most common point of infection outside the 
parturient tract after labor is some portion of the urinary apparatus, 
almost invariably the bladder. The process of parturition necessarily 
diminishes the vitality of the vesical mucous membrane cells by the 
pressure and stretching to which they are subjected. After labor, 
therefore, they are not in a condition to resist the attacks of micro- 
organisms, should these in any way gain access to the vesical cavity. 
Most commonly microbes are introduced into the bladder by a catheter. 
This, however, is not necessary, as it has been plainly demonstrated 
that they can wander from the vaginal canal through the urethra into 
the bladder without the intervention of an instrument which would 
directly carry them into the vesical cavity and deposit them in that 
situation. Once arrived within the bladder, the microbes attack the 
depressed bladder-cells, and very often gain a lodgement in the vesical 
mucous membrane. This is manifested by the usual symptoms of 
septic cystitis — fever, pus in the urine, pain on pressure over the hypo- 
gastrium, and pain and difficulty in micturition. The duration of 
these symptoms is, as a rule, not very long. The fever subsides and 
the symptoms of cystitis disappear. After an interval of some days, 
however, there is again a sharp outbreak of fever, with pain in the 



768 DISEASES. 

region of the kidneys, the reappearance of pus, or at least of numerous 
microbes, in the urine, and a marked leucocytosis. This indicates a 
septic infection of the pelves of the kidneys after the micro-organisms 
have migrated along the ureters. During their migration their pres- 
ence has not been manifested by any symptoms. In the majority of 
cases even the symptoms of pyelitis will disappear after a time, and the 
patient will make a good recovery; but in a certain proportion there 
is a systemic infection by the direct passage of microbes or their 
products from the kidneys into the blood. There may be an extensive 
suppuration of the kidneys and surrounding tissue, with fatal results, 
or, as the writer has seen in several cases, the symptoms of general 
systemic infection become so grave as for a long time to threaten the 
patient's life. In the worst cases of bladder infection the mucous 
lining sloughs, peritonitis develops, and the patient dies before the 
disease has time to infect the kidneys. 

The practitioner, bearing in mind the serious consequences of septic 
cystitis after labor, should always be on the watch for it, and should 
adopt an energetic treatment immediately upon its detection. A thor- 
ough disinfection of the bladder will remove all present symptoms, 
and prevent the occurrence of grave and possibly fatal after-complica- 
tions. To accomplish this purpose the writer employs a saturated 
solution of boric acid. One injection of a quart of this solution 
through a two-way catheter is usually sufficient. Occasionally it is 
necessary to repeat it or to follow it by several injections of boric acid 
solution. A 1 : 8000 bichloride of mercury solution may be employed 
if the first boric acid injection fails to improve the local symptoms. 

If, in spite of all precautions, infection of the kidneys should ensue, 
a vigorously stimulating and supportive plan of treatment affords the 
only hope of success. If extensive suppuration occurs in the kidneys, 
all treatment will of course be useless. 

Perhaps the most uncommon point of septic infection after labor is 
the rectum. The writer has, however, seen one fatal case of this sort — 
from the use, no doubt, of a dirty syringe-nozzle in the hands of a care- 
less nurse. It would be difficult, or perhaps impossible, to diagnosti- 
cate such a case until after death, and therefore treatment directed 
toward this form of infection will usually not be adopted. 

Next in frequency to the parturient tract and the urinary system as a 
region of infection after labor come the breasts. Infection of the nipples, 
and a consequent mammary inflammation or suppuration, is one of 
the most troublesome minor complications that the obstetrician is 
called upon to treat. By careful preparation of the nipple during the 
last month of pregnancy, by extreme care to secure perfect cleanliness 
during the period of lactation, by emptying the breast and supporting 
it with a mammary binder, infection of the breast can almost surely be 
avoided. If it occurs, the first effort should be to limit its extent and 
degree, and to prevent, if possible, suppuration. The best means to 
accomplish this end are derivation of the blood from the mammary 



PUERPERAL DISEASES. 769 

glands by an active purge, compression of the gland-substance, and 
support of the breasts by a suitable mammary binder. 

To these should be added, in the acute stage of inflammation, 
fomentations of very hot water, or the ice-bag, and, later, the applica- 
tion of cloths wrung out in lead-water and laudanum, renewed every 
three hours. Unless the infection has been of a virulent nature and 
the amount of infective material large, this plan of treatment will 
almost surely dissipate the inflammation and prevent suppuration. 

The other infectious fevers of the puerperal state include the infec- 
tious diseases which can, under any circumstances, attack the adult 
female, and their treatment differs in no respect during the puerperium 
from that adopted under ordinary circumstances unless there should 
be developed some local complications. 

Non-infectious Diseases of the Puerperium. 

Anomalies of Involution. — Superinvolution, an exaggeration of that 
process by which the uterus is reduced to its normal size after labor, 
manifests itself, as a rule, only after the puerperal state is completed, 
and therefore its treatment need not be considered. 

Subinvolution, an arrested or retarded return of the uterus to its 
normal condition and dimensions after labor, is one of the commonest 
complications with which the obstetrician has to deal in the manage- 
ment of the puerperium. The cause of subinvolution is always a 
local one. General conditions, as acute fevers, have no influence what- 
ever upon the process of involution unless they are accompanied by 
some local complication. 

There are two causes which prevent the involution of the uterus 
which must be borne in mind when one is called upon to treat this 
condition. The involution may be prevented, on the one hand, by 
anything which brings an excessive amount of blood to the uterine 
body, as, for instance, small fibroids within its walls or hypertrophied 
deciduous membrane remaining adherent to its inner surface. On the 
other hand, subinvolution may be the result of mechanical obstruction 
to the contraction of the uterine walls and the reduction of the cavity 
of the uterus to the normal size. An example of this is a retained 
placenta or a submucous fibroid or adhesions dragging the uterus out 
of place and preventing its contraction, or, most commonly perhaps, 
an overdistended bladder and rectum. 

In those conditions which result in a hyperemia of the uterus the 
cause of an excessive blood-supply must be sought out and removed 
before the subinvolution can be remedied. 

If small fibroids can be detected, the administration of ergotin 1 
grain, hydrastinin \ grain, and stypticin 1 grain, in pill form, has been 
found most useful. If practical, a faradic current may be employed 
in addition to medication. If there is an hypertrophied endometrium 
retained within the uterus, a curette will most quickly and effectually 

49 



770 DISEASES. 

hasten involution. In cases of heart disease in which the blood-cur 
rent is sluggish and dammed back into the large veins of the trunk 
digitalis will be the most effective remedy to overcome the subinvolu- 
tion. There may be an active hyperemia associated with inflamma- 
tory action, either in the uterine wall or upon its peritoneal covering 
or in its adnexa; in this case the inflammation must be overcome by 
disinfection, the use of purgatives, the local application of hot water, 
or possibly operative treatment, before involution can be secured. 
When there is mechanical obstruction to the return of the womb to its 
normal dimensions, the hindrance must, of course, be removed before 
one can expect a good result from treatment. In the case of retained 
adherent placenta every effort must be made to remove the placental 
tissue. In the case of submucous fibroids their removal must be 
attempted if there is any hope of safely accomplishing it. 

There is no case of labor which does not leave behind, in the par- 
turient tract, some injury of the maternal structures. Usually these 
are slight in degree, manifesting no symptoms and healing spontane- 
ously. Occasionally the injury done results in fistula communicating 
with the bladder or rectum, in deep granulating wounds in the vagina, 
or in ulcerated sores. 

In the case of fistula a cure can sometimes be effected without 
operative interference by touching up the edges of the fistulous tract 
with nitric acid, in order to excite an outpouring of granulation-tissue 
in the hope that it may plug the opening. In deep tears, which 
have not been primarily united, application of a solution of nitrate 
of silver will hasten the cure and prevent infection of the wounded 
surface. If ulceration occurs, the ulcerated spots are to be carefully 
watched and treated in the same manner. All the injuries of the 
birth-canal should be repaired by primary, intermediate, or secondary 
operation. 

Hemorrhages from the birth-canal after labor depend upon a num- 
ber of well-known causes, which must be sought out and corrected 
before the bleeding will cease. Most frequently the cause of a hemor- 
rhage will be found in retained placental fragments, which must be 
removed. Frequently displacements of the uterus will be found as a 
cause, and correction of the displacement will check the bleeding. 

In interstitial bleeding after labor, resulting in hematoma, care 
must be taken to preserve the parts in as aseptic a condition as pos- 
sible, while an attempt is made to limit the bleeding by the application 
of direct cold, preferably by means of a colpeurynter dilated with ice- 
water, which must be removed from time to time in order to allow 
the lochia to escape. After rupture or incision of these blood-tumors 
the cavity left behind must be carefully disinfected with bichloride of 
mercury solution, and, if necessary to control further bleeding, well 
packed with iodoform gauze. 

Of all forms of bleeding, that which occurs directly after labor in 
consequence of inertia uteri, known as post-partum hemorrhage, is 



PUERPERAL DISEASES. 771 

the most frequent, the most alarming and dangerous in its manifesta- 
tions and consequences. No one should attend a case of obstetrics 
without having in mind a clearly defined programme to be put in 
immediate execution when called upon to deal with this frequent and 
dangerous complication. There are two indications to be met: first, 
to control the hemorrhage, and, second, to treat the after-condition. 
The first indication is met by the following plan of treatment : 

External stimulation of the uterus by kneading and rubbing through 
abdominal walls, as is practised in Crede's method of expressing the 
placenta. 

If this fails carry the hand into the uterus and remove any blood- 
clots, pieces of placenta or membrane that may be found there, and 
manipulate the parts so that the internal surface of the uterine walls 
is irritated by the movements of the operator's fingers, which are 
covered by a sterile glove. 

Next apply a small piece of ice upon the abdomen externally. 
The use of cold must not be persisted in for more than a minute at 
most, for its ultimate action is depressing and relaxing. 

If all these measures fail the physician should resort to the use of 
sterile water at a temperature of 116° or 120° F., which should be 
injected into the uterine cavity. 

If one happens to have the necessary appliances at hand (a small 
Gaiffe battery, which can be carried in an ordinary instrument-bag), 
a strong faradic current can be applied to the uterine muscle. 

Finally, as a last resort, the uterine cavity may be packed with long 
strips of iodoform or sterile gauze in the manner suggested by Diihrssen 
and carried out by a number of observers with gratifying success. 

The physician should give ergot in full dose by the mouth and, if 
need be, hypodermically. (Ergone or ergot aseptic.) 

Drugs, as the styptic salts of iron, and especially Monsel's solution, 
have been recommended from time to time as intra-uterine applica- 
tions in the case of post-partum hemorrhage, but they are dangerous, 
for the coagulation produced by them may extend far into the uterine 
vessels, and the clots can only be broken up by putrefaction, exposing 
the patient to the danger of septic poisoning. 

This programme is to be carried out in the order given: if the milder 
measures suffice, of course the more radical plans of treatment need 
not be employed. 

Excessive hemorrhage (post-partum) from lacerations along the 
genital canal can be controlled by well -placed sutures. 

Bearing in mind this plan of treatment, it is almost inconceivable 
that an intelligent and skilful practitioner should lose a case of post- 
partum hemorrhage. 

Treatment of the After-condition. — While the physician is busy 
controlling the hemorrhage the nurse should administer a hypodermic 
injection of ether if symptoms of shock or collapse are manifested. 
After the bleeding has ceased it is well to administer an enema of a 



772 DISEASES. 

pint of hot normal salt solution, which maintains the patient's tem- 
perature, relieves the shock, and by its irritation promotes contraction 
of the uterine muscle. The submammary or intravenous injection of 
normal salt solution is more efficient than the enteroclysis, but more 
difficult for the ordinary physician to administer. This should be 
succeeded by small doses of hot, strong brandy-and-water, and a little 
warm milk if the stomach will retain it. As soon as reaction is well 
established a half -pint (240 c.c.) of hot beef -tea should be administered, 
and a hypodermic of J- grain (0.008) of morphine given in order to 
secure quiet and rest and to get the stimulant qualities which this drug 
undoubtedly possesses. Occasionally measures must be adopted to 
retain enough blood within the large vessels and in the heart to prevent 
excessive cerebral aii£emia or cardiac failure. This is best done by 
auto-transfusion; that is, by bandaging the extremities from below 
upward, in order to secure as large a quantity of blood as possible 
within the vessels of the trunk and brain. Actual transfusion 
of a 0.6 per cent, solution of common salt into the bloodvessels is 
required when there are profound exhaustion and depression after 
hemorrhage. It has been demonstrated that it is not necessary to 
throw this solution directly into the bloodvessels, as interstitial injection 
seems to answer the purpose equally well. The most convenient 
place for such injections in females is under the breasts. (See Hypo- 
dermoclysis, Part III.) 

The milk secretion during the puerperal state presents abnormalities 
which call for treatment. One may have to deal with anomalies of 
quantity or quality. The most frequent anomaly of quantity in milk 
secretion is unfortunately one of deficiency. Insufficient milk-supply 
depends on a number of causes. Perhaps the most frequent is a lack 
of development of the glandular tissue, and in this form of insufficient 
milk secretion no treatment can be of avail. When the lack of milk 
is due to some intercurrent affection in the puerperal state the treat- 
ment must be directed toward this complication before the milk-supply 
can be re-established in normal quantity. It may be the consequence 
of hemorrhages or of diarrhoea, or the result of an acute febrile attack 
during lactation, or of inflammation within the gland itself. Serious 
organic disease may also be a cause, and insufficient nourishment 
must be held accountable in some cases. Profound emotions exert 
an extraordinary influence upon lactation in altering both the quantity 
and the quality of the milk. It has long been supposed that the return 
of menstruation has a disastrous influence upon milk secretion. This, 
however, has been definitely disproved by careful observations. The 
return of normal menstruation without complications has no apparent 
influence, as a rule, upon the quantity or quality of the woman's milk. 
In all the temporary diseases interfering with milk secretion described 
above it should be borne in mind that on the disappearance of the 
abnormal general or local condition milk secretion can be successfully 
re-established even though it be absent for days or weeks. Electricity 



PUERPERAL DISEASES. 773 

has been much vaunted as a remedy for insufficient lactation. It may 
be applicable in cases of torpidity of the mammary gland or in those 
cases where lactation has been suppressed on the birth of a first child, 
and where the mammary gland, therefore, does not respond readily to 
the stimulus of subsequent births. This remedy will, however, often 
prove ineffective and disappointing. 

Instances of excessive milk secretion are not infrequently met 
with. The milder and simpler forms can be managed by regulation 
of the diet and free purgation. Galactorrhcea, a constant flow of 
milk from the breasts, is one of the most stubborn forms of excessive 
milk secretion. Two measures can usually be relied on to give relief: 
firm compression of the mammary gland with the application of bella- 
donna ointment, and the administration internally of iodide of potas- 
sium. In some cases of this character milk secretion stops spon- 
taneously with the return of menstruation, and in a certain proportion 
of cases a treatment to secure a discharge of blood from the uterus 
has been successful in stopping the flow of milk. Success has been 
obtained with Simpson's plan of introducing a piece of caustic within 
the uterus in order to bring back the menstrual flow, but this local 
treatment has been superseded by the safer plan of applying the 
negative pole of a galvanic current (15 milliamperes) in utero. Warm 
douches have been used successfully. Electricity to the mammary 
glands has been recommended to secure the proper contraction of the 
sphincter muscles of the lactiferous ducts, but as this is usually a result, 
and not a cause, of the galactorrhcea, the use of electricity must prove 
in the vast majority of cases ineffective. The long-continued admin- 
istration of ergot has been warmly recommended. The remedy should 
be tried, for its use is rational. Chloral has been shown to be very 
effective in diminishing the quantity of milk. This drug, therefore, 
is worthy of trial. It has been declared that antipyrine, in 2^-grain 
(0.15) doses three times a day, will diminish milk secretion. The 
drug, however, has not been tested often enough to demonstrate its 
power. Quantitative anomalies in the milk secretion must often 
depend upon an ill-regulated diet. A fatty diet will diminish the 
quantity of milk; a vegetable diet will diminish the casein, and fat 
will increase the sugar; a diet rich in meat, especially if reinforced 
with alcoholic stimulants, will increase the fat and casein, but will 
diminish the sugar. If the mother's milk is evidently disagreeing 
with the nursing infant, a chemical analysis of it should be made, and 
on the result rules regulating the diet should be adopted. The most 
common mistake in practice is to overfeed a nursing woman, espe- 
cially with a milk diet, with the idea which prevails extensively among 
the laity that the cows' milk poured into the stomach appears again 
in the mammary gland. It is usually sufficient for a nursing woman 
to observe the ordinary diet which agrees with her under all circum- 
stances, with the addition perhaps of a half-pint of milk midway 
between the morning and mid-day and mid-day and evening meals. 



774 DISEASES. 

Occasionally a wineglassful of malt at the mid-day and evening meals 
is a useful addition to the diet, and in anaemic patients the addition 
to the malt of 5 grains (0.3) of pyrophosphate of iron will be an advan- 
tage. 

There is found in every pregnant woman some alteration in the 
constitution of the blood, which consists, roughly speaking, of a dimi- 
nution of the red blood-corpuscles and of the albumin and the iron 
in the blood, with an increase in the white blood-corpuscles and the 
serum. In some cases this change is much exaggerated, so that an 
intense degree of anaemia appears in the puerperal state which, in 
its severity, will stimulate pernicious anaemia or some fatal form of 
blood disease. The anaemia of puerperal women, however, even in 
severe cases, usually yields to treatment in a most gratifying man- 
ner. After the prolonged use of Blaud's pills the writer has seen 
the blood-corpuscles rise from less than three to nearly four and a half 
millions, and the haemoglobin increase from 40 to 75 per cent, in a few 
weeks. In some cases arsenic alone succeeds where iron fails com- 
pletely. 

Eclampsia. 

To treat eclampsia intelligently and successfully it is necessary to 
understand its etiology as fully as modern knowledge permits. Although 
the subject needs more light from future investigations, enough is now 
known to justify the following statement: 

1. The cell-activity of mother and foetus produces excrementitious 
substances which are poisonous to the whole organism unless they are 
voided or made harmless by the excretory organs. 1 

2. The organs in the childbearing woman are often inadequate to 
the disposal of effete material from the maternal and foetal bodies. 

3. Consequently, poisons, of a nature not yet demonstrated, are 
stored up in the maternal blood until, by cumulative action, their 
presence is manifested in the eclamptic seizure and other symptoms. 

4. The convulsions are probably the result of an acute cerebral 
anaemia brought about by violent contraction of the arterioles, possibly 
by direct irritation of the brain-substance or perhaps by the emboli of 
giant cells from the placenta, described by Echinard. As a result of 
intense muscular action the circulation is interfered with, and blood is 
determined into non-muscular regions, as the brain, lungs, kidneys, 
etc., to such a degree that the congestion of these parts becomes dan- 
gerous, leading to apoplexy in the brain, oedema in the lungs, and 
often a complete abrogation of renal function. 

The indications for treatment in convulsive seizures of this nature 
are plain : 

First, to eliminate the poisons from the blood as quickly and in as 
large quantities as possible. Second, to diminish nervous sensibility 

1 Harold C. Ernst, American System of Obstetrics, vol. ii. p. 431. 



PUERPERAL DISEASES. 775 

and lessen muscular power, in order to reduce the convulsions in 
vehemence, duration, and frequency. Third, if convulsions occur 
during labor, to save the infant without adding to the risk of the 
mother. Fourth, to guard the woman from injury during the attack. 

The first indication is met by venesection, diaphoresis, and catharsis. 
By the first, one eliminates a certain quantity of poison along with the 
blood and relaxes the muscles. If there is sharp post-partum hemor- 
rhage, or if the patient is from any cause weak and anaemic, blood- 
letting is not called for. In the ordinary case, however, with full 
pulse, congested head, the veins standing out upon the neck and face, 
venesection is an undoubted advantage. While the median basilic 
of one or both arms is being opened some croton oil should be sent for, 
and 2 minims (0.1) mixed with sweet oil may be placed upon the 
tongue. Directions should at the same time be given to wring out 
three or, better, four old blankets in boiling water; these are wrapped 
around the legs, trunk, and arms, and well covered over with one or 
more dry blankets. A hot-air bath, or immersion of the patient's 
body in a bath-tub full of hot water, is equally efficient. A submam- 
mary injection of a pint of normal salt solution is an extremely valuable 
aid in producing free diaphoresis. The sweating thus induced is 
profuse. An ice-bag must be put to the head to prevent overcon- 
gestion of the brain. In this way, directly and indirectly through the 
skin and bowels, one eliminates the cause of eclamptic convulsions as 
quickly and thoroughly as possible from the blood. The latter may 
be acted upon by \ grain of elaterium rubbed up in butter, or by 
compound jalap powder and calomel, instead of the croton oil. 
Pilocarpine seemed at one time an ideal remedy to secure diaphor- 
esis in eclamptic cases, but it has fallen into well-deserved disre- 
pute. It much increases the danger of pulmonary oedema, and is 
too profound a depressant. It is no longer employed by experienced 
obstetricians. The second indication is best met by an anaesthetic. 
Usually the convulsion first shows its approach in the eyes: these 
should be closely watched, so that on the first symptom of the oncom- 
ing attack chloroform may be at once administered and pushed as 
rapidly as possible. Ether is inadmissible in these cases, for it is slow 
of action, congests the brain, and irritates the kidneys. Just before 
the woman is wrapped in blankets 1 drachm (4.0) each of chloral and 
bromide of potassium in starch-water should be injected into the 
rectum. This may be repeated in an hour if necessary. Morphine, 
veratrum, and inhalations of nitrite of amyl have their enthusiastic 
advocates in this connection. They may be held in reserve in case the 
plan of treatment described needs reinforcement. 

If convulsions come on during labor, the child should be rapidly 
extracted as soon as the os is well dilated, but not before, because 
efforts to dilate the os increase the convulsions, and attract the phy- 
sician's attention from the woman's most threatening danger. More- 
over, the os dilates with unusual rapidity during eclampsia. 



776 DISEASES. 

The only injury to be feared during eclamptic attacks is wounds 
of the tongue from the teeth. They can be prevented by inserting 
between the teeth a brush-handle wrapped in a handkerchief or by 
drawing a towel into the mouth like a bit. Well-meaning but igno- 
rant bystanders sometimes throw themselves upon an eclamptic 
patient to restrain her convulsions by force. This should be forbidden. 

REMITTENT FEVER. 

This is sometimes called bilious fever by reason of the violent bilious 
vomiting and jaundice which often accompany it. It separates itself 
from intermittent fever by the fact that the patient's condition, chiefly 
as regards temperature, does not have normal intervals, but has periods 
of only temporary improvement, or, in other words, the disease remits. 
Not only is this true, but it is also to be remembered that the sestivo- 
autumnal parasite which produces remittent fever is more difficult to 
destroy than the tertian or quartan forms, and that larger doses of 
quinine are needed for this reason. 

For the proper treatment of this fever, three facts must be borne 
in mind: 1. It is more dangerous than intermittent fever. 2. It is 
dangerous in the hot stage, not in the cold stage. 3. The patient, 
not having periods for complete or partial recovery, rapidly loses 
strength. The safety of the patient depends upon the use of large 
doses of quinine to cut short the pyrexial stage, the doses used being 
from 20 to 30 grains (1.3-2.0) a day or 5 grains (0.30) every four hours, 
preceded by a good-sized purgative dose of calomel, say 3 or 4 grains 
(0.20-0.25). If vomiting is too violent to permit of the retention of 
the quinine, it must be used by the rectum and hypodermically, the 
stomach and intestines being first swept out by the use of divided doses 
of Seidlitz powder or citrate or sulphate of magnesium. If purgatives 
are used, they should precede the quinine by twenty minutes, as other- 
wise the latter drug is swept out in the bowels, where it is rendered 
useless by reason of its precipitation by the alkaline juices there pres- 
ent. Many clinicians claim that remittent fever is chiefly benefited 
by quinine during the remission, and cinchonism during the pyrexial 
stage undoubtedly increases the discomfort of the patient. If pyrexia 
is excessive, relief must be sought in the use of cool sponging with 
frictions. Cure is much facilitated by absolute rest in bed. 

The best treatment of the vomiting is the use of small doses of 
morphine, or 3- to 5-minim (0.20-0.3) doses of chloroform in from 
30 drops to 1 drachm (2.0-4.0) of cherry-laurel water. Aconite may 
also be used if the patient is strong enough. (See Vomiting.) 

If the belly is tender, a turpentine stupe should be applied. (See 
Turpentine.) 

If intestinal hemorrhages occur, gallic and tannic acids or Monsel's 
salt, in the dose of 3 grains (0.20) in hard pills, may be used, and cold 
cloths be placed over the belly. (See Hemorrhage.) 



RHEUMATISM {ACUTE ARTICULAR). 777 

If hematuria appears and the malarial parasite is found in the blood, 
quinine must be used, but it must be remembered that quinine in 
some cases increases the hematuria. (See Cinchona and Collective 
Investigation by author in Therapeutic Gazette, July, 1892.) 

The treatment of convalescence consists in the use of tonics, such as 
quassia, calumba, gentian, Huxham's tincture, arsenic, and purgatives 
when needed, with attention to the kidneys, the potassium salts being 
employed to keep these organs active. (See Intermittent Fever.) 

RETINITIS. 

Retinitis, or inflammation of the retina, often associated with cho- 
roiditis, is commonly the result of several constitutional diseases: 
Bright's disease, diabetes, syphilis, etc. In some cases no cause can 
be found. The general remedies must be directed according to the 
supposed cause, and the eyes must be protected from light and all 
close work avoided. Very distinct retinal irritation may be caused 
by eye-strain, which is to be relieved by the prolonged use of atropine 
and dark glasses, and later suitable lenses for the correction of any 
existing error in refraction. 

RHEUMATISM (ACUTE ARTICULAR). 

No better example of the fact that therapeutics is in advance of 
pathology can be adduced than the disease known as acute rheu- 
matism. The therapeutist cannot tell how he cures the condition 
designated by this name, simply because the pathologist cannot tell 
what the cause of the disease is, and when this information is forth- 
coming from the one side, an explanation will probably be given by the 
other. This being the case, we must devote ourselves to the study of 
pure empiricism, and not to rational pharmacology. 

The treatment of acute articular rheumatism is divided into that 
portion devoted to the cure of the disease-process, and that directed 
to the relief of the pain and of the other local manifestations of the dis- 
ease. 

When an acute attack of rheumatism comes on, it is nearly always 
accompanied by a high temperature, a bounding pulse, and all the evi- 
dences of the active systemic disturbance accompanying inflammatory 
outbreaks, which, in this particular instance, involve the joints. We 
may therefore use at such times the remedies which we have learned 
are best able to combat inflammation — namely, aconite and veratrum 
So powerful are these drugs in the early stages of acute rheumatism 
that some persons have believed them to be possessed of a specific 
antirheumatic power. This is, however, highly unlikely, as they act 
no better here than in inflammatory conditions elsewhere. 

The proper manner in which to use the tincture of aconite under 
these circumstances, in a strong, healthy individual, is to administer 



778 DISEASES. 

10 minims (0.60) at once in a little water, and follow it by a teaspoon- 
ful of a mixture containing 15 minims (1.0) of tincture of aconite and 
2 ounces (60.0) of water, every half-hour until perspiration on the 
skin betokens circulatory depression through the action of the drug. 
If this is not used, veratrum in the same proportions may be given. 
The advantages of this treatment are numerous: first, it allays the 
fever; second, it quiets nervous excitability; and, last of all, it aids in 
the production of a sweat. Whenever these drugs are employed the 
patient must be strong and hearty, not debilitated or weak. Finally, 
care is to be taken that the symptoms of depression from the drug and 
the disease combined do not become too severe. Where great exhaus- 
tion is primarily present or ensues upon the use of depressant drugs, 
carbonate of ammonium and aromatic spirit of ammonia are valuable. 

Simultaneously with these internal measures a solution of bicar- 
bonate of sodium, 20 grains to the ounce (1.3-30.0), may be applied to 
the joints involved, by means of lint wet with this solution, with dimi- 
nution of the sense of heat or burning, or ice-cold compresses may be 
tried. In other cases relief may be obtained by applying hot cloths 
saturated with the so-called Fuller's lotion — namely, carbonate of 
sodium 6 drachms (24.0), laudanum 10 ounces (300.0), glycerin 2 
ounces (60.0), and water 9 ounces (270.0). Sometimes much benefit 
can be obtained by fixation of the joints by means of splints. 

A most valuable application to the inflamed joints of rheumatism, 
and the one the author always employs, both during the acute stage 
and afterward when they remain swollen and enlarged, is: 

I$— Ichthyol . • gij (60.0). 

Adipis lanae hydros Bij (60.0). — M. 

S. — Rub in well and apply about the inflamed part on lint. 

In other cases the acute stages of the inflammation may be combated 
with advantage, particularly where there is gastric disorder, by the 
local application of salicylic acid made into an ointment with an animal 
fat, not vaseline or glycerin, as it is not absorbed when so mixed. 
According to Bourget, this treatment is best suited to blondes and 
young persons, as absorption is more rapid in this class of patients. 
The following salve may be prescribed : 

1$ — Acid, salicylic oj (4.0). 

01. terebinthin. rnxxx (2.0). 

Adipis lanae hydros oj (30.0). — M. 

High fever is to be controlled by the same measures as the high fever 
of any other disease — by cool sponging, or sponging with tepid water, 
and sometimes by the use of antipyretic drugs, the use of which is 
more justifiable in this case than in ordinary fevers in that they tend 
to relieve the pain. 

Immediately after the system has been thoroughly impressed by 
cardiac sedatives — or at once and in their place if the case is not 
seen at first or is weak — the physician should resort to salicylic acid 



RHEUMATISM {ACUTE ARTICULAR). 779 

or its salts. It is worthy of note that good results generally follow 
rapidly; that is, the salicylates give relief in from three to four days, 
or fail altogether. It is most important to remember that salicylic 
acid protects the cardiac valves and the entire endocardium from 
the ravages of the disease only by shortening the attack, and not by 
any direct influence; and in addition that this acid, by reason of the 
profuse sweats often produced by it and its tendency to cause cardiac 
depression, must be watched lest it act unfavorably on the general 
systemic state. 

The proper use of salicylic acid is often misunderstood, and it fails 
to produce good results sometimes because of this fact. When- 
ever acute articular rheumatism appears the salicylic acid should be 
pushed in the same way that we use quinine on the advent of a malarial 
paroxysm — namely, in full dose. 

It is useless to give salicylates in 5- or 10-grain (0.3-0.60) doses 
three times a day; they must be given in 20- to 30-grain (1.3-2.0) 
doses, morning, noon, and night, or oftener, or not at all. If the 
sweats are too severe or the stomach rebels, they may be stopped, but 
not decreased in amount unless for good reason. Further than this, 
if salicylic acid is used for three or four days in this way, and produces 
evidences of cinchonism, yet fails to alter materially the course or 
severity of the trouble, it should be withdrawn, as it will rarely if ever 
do any good after this time. (See article on Salicylic Acid.) 

Lees also asserts that the salicylates often fail in acute rheumatism 
because the dose is not large enough. He advocates as much as 300 
grains a day to a child, and insists that large doses of bicarbonate of 
sodium are necessary to prevent evil effects from these doses. The 
chief of these is "air hunger" or dyspnoea. The author would be 
afraid to use such large amounts, but this view of Lees emphasizes 
the fact that the doses used are often too small. 

In the author's experience the salicylate of strontium is a very useful 
substitute for the acid, as it is less apt to irritate the stomach. 

Clinical experience seems to show that if sodium bicarbonate is 
given in full doses with the salicylates, better results are obtained 
than if the salicylate is used alone. • The dose of the bicarbonate of 
sodium should be about 20 or 30 grains (1.3-2) three or four times 
a day. It is also thought that this mixture protects the heart, whereas 
the salicylate when given alone fails to do so. 

Acetanilid does good by benumbing the sensibility of the patient to 
the excruciating pain consequent upon movement, and so putting aside 
the nervous wear and tear of sleeplessness and suffering.. Further 
than this, it would seem probable that acetanilid possesses a direct 
antirheumatic influence. The author has found that acetanilid in such 
cases will often relieve the pain, and so permit a refreshing sleep, in 
doses of from 4 to 8 grains (0.25-0.50) three times a day, and that these 
amounts do not cause the excessive sweating which the necessarily 
large doses of salicylate are sure to produce — sweats which leave the 



780 



DISEASES. 



patient oftentimes almost dyspnoeic from very weakness. Whether 
this temporary relief produces such changes in the system as to permit 
of a better battle against the disease, or whether it actually counteracts 
the rheumatic poison, we do not know. 

The following prescription, which is of additional value because 



the caffeine supports 
recommended : 



the heart and increases urinary secretion, is 



Py— Acetanilid gr. xl (2.6). 

Caffein gr. xx (1.3). 

Camphor, monobromat gr. xx (1.3). — M. 

Ft. in capsul. vel pil. No. xx. 

S. — One every three hours or three times a day. 

Phenacetin is often very useful when used in rheumatism for the 
relief of pain, particularly if combined with phenyl salicylate. 

Passing from what may be appropriately called the coal-tar treat- 
ment of rheumatism, because all the drugs so far named for internal 
use have such a source, we come to a list of remedies heretofore largely 
used in rheumatism in place of the newer compounds, but which are 
not so commonly employed to-day. 

These remedies act, as a rule, in the subacute forms of rheumatism 
or in the cases where the first group fail because the disease is obsti- 
nate. Of these the chief is the iodide of potassium, followed by the 
acetate, bicarbonate, and citrate of potassium. If the iodide is used, 
the following prescription is of service : 



Py— Potassii iodidi . §j (30.0). 

Syr. sarsaparillse comp f 5vj (180.0). 

—Dessertspoonful (8.0) three times a day, after meals. 



-M. 



In other cases it is best, because of the disagreeable taste of the 
iodide, to give it in sugar-coated pill or in tablet form, but care 
should be taken that milk or water is taken at the same time to prevent 
gastric irritation. 

Or, if preferred, 20 to 30 grains (1.3-2.0) of the bicarbonate of 
potassium may be taken every four or five hours in water flavored with 
cinnamon for the sake of the taste, or the citrate of potassium, which 
is more agreeable, may be taken in equal amount. If the case is very 
obstinate, sometimes a little colchicum added to the prescription given 
above may be useful, as follows: 



I£— Potassii iodidi gj vel gij (30.0-60.0). 

Vini colchici seminis .... f^ss vel f % j (16.0-30.0). 
Syr. sarsaparillae comp. q. s. ad f^vj vel f Jxij (180.0-360.0). 
S. — Dessertspoonful (8.0) three times a day, after meals. 



-M. 



Haig claims that in rheumatism there is retention of uric acid, and 
that the use of alkalies and the salicylates at once causes this substance 
to be changed into a soluble form ready for elimination. 

The other drugs used in acute rheumatism are numerous, but only 



RHEUMATISM [ACUTE ARTICULAR). 781 

a few of them deserve attention here. There is abundant evidence 
on record that full doses (10 to 30 minims [0.60-2.0]) of the fluid 
extract of cimicifuga if given every five hours will decrease the redness 
and pain of the joints and shorten the attack in some cases. Again, 
certain species of rhus, as rhus toxicodendron, are said to be useful if 
fresh preparations are at hand. The dose of rhus toxicodendron is T ^ 
to 1 minim (0.005-0.05) of a tincture made by adding 1 part of the 
fresh leaves of poison-ivy to 2 parts of alcohol, this dose being taken 
three times a day. Where the pain seems particularly severe at night 
this drug is said to be valuable, but the writer has had no experience 
with it. 

Nearly every case of acute rheumatism will do better if a strong 
mixture of lemon- or lime-juice and water be taken daily in large 
quantities. 

The local remedies in the later stages of acute rheumatism are 
chiefly counterirritants and sedatives. Thus, small or large blisters 
applied around a stiffened joint after the general systemic excitement 
has passed may be of great value in restoring the suppleness of the 
joint and in aiding in the absorption of the effusion. The remaining 
local treatment consists in thoroughly painting the stiffened joints 
with tincture of iodine if blisters are not used, or in the application of 
veratrine ointment or iodine ointment around the joint. (See Vera- 
trina.) Sometimes the application of ichthyol and lanolin in equal 
parts, also rubbing this ointment into the tissues thoroughly, will aid 
in the absorption of inflammatory exudates. 

In this connection we must not forget the great value of morphine 
in endocarditis, myocarditis, and pericarditis; for not only does this 
drug give relief from the pain, but it also diminishes the patient's 
anxiety, quiets his restlessness, and slows the pulse by this means and 
by direct action upon the circulatory system. This question of slowing 
the heart does not receive sufficient attention. When we consider 
that a difference of ten beats a minute amounts to 600 beats per 
hour, and to nearly 15,000 beats a day, we can see how comparatively 
slight variations in pulse rate may mean very great variations in the 
amount of work done by the heart in twenty-four hours. For the pre- 
vention or relief of endocarditis the application of a number of small 
blisters over the prsecordium seems to be a very valuable measure; 
or, in their place, 8 to 12 leeches may be placed over the heart and 
followed by the application of an ice-bag. (See article on Peri- 
carditis.) 

No drugs can serve to protect the heart so well as complete physical 
rest. Not only is this necessary during the attack, but for several 
weeks afterward; and if the patient gets up too soon, a latent, unsus- 
pected valvulitis may gradually develop into a fatal lesion. The 
lame valve must be given time to recover before it is given more work 
to do. This is perhaps the most important therapeutic fact in regard 
to the therapy of this disease. 



782 DISEASES. 



EHEUMATISM (CHRONIC). 

Chronic rheumatism is one of the most obstinate diseases with 
which we have to deal. In some cases the acute form just con- 
sidered merges slowly into the chronic form, or, in other instances, 
the disease develops gradually, increasing, it may be, by exacerba- 
tions or by gradual progression. The treatment of chronic rheuma- 
tism is somewhat different from that of the more acute forms, and 
approaches that of gout in some of its therapeutical indications. In 
other words, the salicylates are not so useful in these cases as are the 
iodides and colchicum, so that in the majority of instances the pre- 
scription of iodide, sarsaparilla, and colchicum given in the article on 
Acute Rheumatism is indicated. When anaemia or weakness is pres- 
ent, cod-liver oil is often of great service, and it is worthy of note that 
this useful nutritive remedy was first brought into therapeutics by 
the fishwives of Holland, who found it useful in the attacks of 
rheumatism to which their husbands were subjected through ex- 
posure. 

When the oil is thoroughly rubbed into chronically inflamed joints 
it is almost as useful as when taken internally. 

The same forms of severe counterirritation are not so useful in chronic 
rheumatism as in the acute form, but a very valuable therapeutic 
measure in these cases is the use of the Russian or Turkish bath or an 
improvised hot bath by means of a lamp and a blanket. (See Heat and 
Cold.) Liniments are always called for, for two reasons: first, they 
relieve pain and do good to the parts, if not from their medicinal prop- 
erties at least by the rubbing which accompanies their application: 
second, because they give the patient something to do or to have done, 
and therefore impress him with the object-lesson that his attendants 
are attentive and alive to his suffering and need of sympathy and 
care. 

Among the lower classes the belief in liniments is widespread, and 
their use will often instil into the minds of the friends a far greater 
confidence than the most rational of treatments with the liniment left 
out of the list of remedial measures. 

The following liniments wiU be found very useful under these circum- 
stances : 

Py— Tr. aconiti f^vj (24.0). 

Tr. opii fgj (30.0). 

Olei terebinth inse ..... fgj vel_f 5 ij (30.0-60.0). 
Linimenti saponis . . q. s. ad Bviij (240.0). — M. 
S. — Poison. Use as a liniment three times a davr 

Or, 

Py — Aquae ammonise fortior . . . f3iv(16.0). 

Olei cajuputi f 3j (4.0). 

Tr belladonna f |j yelf§ij (30.0-60 0). 

Linimenti camphorae . q. s. ad f §viij (240.0). — M. 
S. — Poison. Use as a liniment. 



RICKETS. 783 

Or, 

R— Tr. acphiti f^j (30.0). 

Tr. opii, 

Aquae amnion, fort aa f giv (16.0). 

Linimenti chloroformi f £vj (180.0.) — M, 

S. — Poison. Use as a liniment to chronically inflamed muscles or joints. 

In other instances the greatest relief is obtained by employing the 
following ointment : 

Py — Veratrinae . . gr. xxx (2.0). 

Hvdrargvri iodidi nav oj (4.0). 

Petrolati" • . . Bij (60.0).— M. 

S. — Use as an ointment over the joints. 

This ointment ought not to be widely distributed, and the pulse and 
respiration should be watched, as the veratrine may be absorbed and 
depression of a severe character set in. 

For the reduction of enlargements of the joints due to the disease, 
and accompanied in some cases by pain, the following ointment is 
serviceable : 

Pr- Unguent, iodi Bj (30.0). 

Adipis 5iv vel §j (16.0-30.0).— M. 

S. — Apply locally. 

Or, still better, 

Py— Ichthyol 3iv to gj (16.0-30.0). 

Adipis §j (30.0).— M 

S. — Rub into the joints thoroughly. 

In many cases ichthyol is certainly the most efficient remedy for the 
enlarged and painful joints. 

The employment of red flannel over inflamed joints is no better 
than the use of white flannel, and it is never beneficially "medicated," 
as claimed in the stores. The only advantage of red flannel is that, as 
it is dyed, the wool is often better for not being thoroughly bleached, 
and is in larger amount. The disadvantages of red flannel are that if 
the patient sweats the dye stains the clothing, and the possibility of 
its producing irritation of the skin or even systemic effects of an evil 
character. 

RICKETS. 

Rickets may be defined as a state of the body of an infant or child 
in which there is a deficiency of the normal salts of the bones and 
tissues, with corresponding enlargement of the organic portion of the 
bone, or, in other words, the cartilaginous parts. Generally the term 
is applied solely to designate bony troubles, but every practising 
physician sees cases where the manifestations of rickets are emphasized 
in gastrointestinal disorders rather than in bony deformities. The 
chief cause of rickets in children, aside from the presence of any dis- 



784 DISEASES. 

ease, such as scrofulosis, is inanition; that is, malnutrition of a 
specialized form, or, in other words, bone-salts starvation. This 
may occur after or before birth, and it is quite common to see children, 
born of mothers ill-fed or whose assimilation of salts is defective, with 
soft bones or a distinct tendency to rickety development. In other 
cases the condition is chiefly one of failure of assimilation more than 
of starvation of bone salts. 

The treatment of rickets is therefore largely dietetic and devoted 
to the improvement of the food and digestion. In the presence of 
this disease no part of the body fails in force more than the diges- 
tive apparatus, probably because the alkalinity of the blood is altered, 
and partly because the stomach cannot secrete properly formed 
juices from imperfectly nourished glands. 

The medicines to be used in rickets are general tonics, digestives, 
and stimulants, and bone tonics, such as salts of lime and phosphorus. 
The general tonics are quinine, and cod-liver oil, mix vomica, and 
iron, while the digestive tonics are the simple bitters, physostigma, and 
mineral acids. 

Tonic treatment is best carried out in young children by the admin- 
istration of quinine in the form of quinine chocolates or by the use of 
strychnine in the dose of t ^-q- to t ^q- grain (0.0003-0.0006) in sugar- 
coated pink granules. Arsenite of copper in the dose of t ^-q grain 
(0.0006) in tablet triturate three times a day is also useful, 

A very useful preparation is the following: 

I$— Olei morrhuae f5vj (24.0). 

Syr. calcis lactophosphat., 

Liquor calcis aa fgiij (90.0). — M. 

S. — \ to 1 teaspoonful (2.0-4.0) two or three times a day. Shake thoroughly. 

Nux vomica is so bitter as to be difficult of administration to young 
children, and when given only \ to \ minim (0.008-0.015) of the 
tincture should be used, three times a day. 

Where a distinct scrofulous tendency exists and anaemia is present, 
small doses of the syrup of the iodide of iron are of service, and \ 
to 1 minim (0.025-0.05) may be given three or four times a day to a 
child of six months or a year, thus: 

1$ — Svrupi ferri iodidi gtt. xij vel xxiv (0.8-1.5). 

Aquae dest q. s. ad fgiij (90.0). — M. 

S. — Teaspoonful (4.0) every four or five hours during the day. • 



Or, 



ly — Svrupi ferri iodidi gtt. xij vel xx (0.8-1.3). 

Syrupi q. s. ad f B ii j (90.0).— M. 

S. — Teaspoonful (4.0) three times a day, after meals. 



Here, again, arsenite of copper is a particularly valuable remedy. 

The salts of lime and sodium are of direct benefit to the bones, 
forming by their presence in health a large proportion of the osseous 
system, and therefore they may be considered as foods rather than 



SCARLET FEVER. 735 

drugs. Very often their administration to nursing mothers or preg- 
nant women saves the maternal teeth from caries and preserves the 
general health of the mother and child. The following prescription 
may be used: 

1$ — Syrupi calcii lactophosphatis . . . f §iv (120.0). 
S. — J to 1 teaspoonful (2 0-4.0) three times a day, after meals. 

The reasons for the use of phosphorus are clear, from what has 
been said of that drug when speaking of it elsewhere in this book, as 
it acts as a direct and powerful stimulant of bone-growth. 

Phosphorus is best given to children in the form of very small sugar- 
coated pills (y-J-q grain [0.0003]), such as are put up in the form known 
as "pink granules. " 

The ventilation of the rooms where a child prone to rickets is kept 
should be excellent, not too hot or cold and free from draughts. A 
cool sponge-bath is useful at night if the patient is strong enough, or 
a good rubbing with salt and whiskey, 1 drachm (4.0) of salt to a pint 
(480 c.c.) of whiskey, is of still greater service. 

Special attention should be paid to the development of the muscles 
by massage and passive movements, as these parts are always weak. 
Walking must not be allowed too early, as it may cause bony deformi- 
ties. 

RINGWORM. 

Many methods of treating this affection are employed and are more 
or less efficacious. Jackson recommends as the best the rubbing into 
the part of 1 drachm (4.0) of iodine crystals in 1 ounce (30.0) of real 
goose-grease. This grease has greater penetrating power than ordi- 
nary fats and usually is effective by the end of three weeks, the ointment 
being applied night and morning till some redness of the skin appears, 
when it is used once a day. Depilation is not necessary, for the hair 
soon falls out, but is supplanted by a new growth. This application 
may burn slightly, but is not really painfuL 

SCARLET FEVER. 

This disease, the most fatal of all the exanthematous diseases of 
childhood, requires the greatest care in its treatment. Complications 
often arise requiring skill on the part of the attendant, and it is upon 
his success in treating these outbreaks, as well as in the general direc- 
tion of the case, that the life of the patient may depend. It has been 
claimed by certain practitioners that one or two remedies, which they 
have used, act as abortifacients of the attack, decreasing its severity, 
its duration, and the probability of complications. Thus, one Euro- 
pean physician has used the salicylates with wonderful results, if his 
claims are true, for he found them to prevent all complications and 
even to remove them when present. He gives, throughout the entire 

50 



786 DISEASES. 

attack and for some days after defervescence has ensued, the fol- 
lowing : 

1^ — Sodii salicylat gr. xlviij (3.2). 

Aquae destillat f 3ij (8.0). 

Syr. aurantii . ,. . . . q. s. ad fgiij (90.0). — M. 
S. — Teaspoonful (4.0) every hour during the day and every two or three hours 
at night, in a little water. 

In the United States some practitioners have employed chloral 
throughout the entire attack, with asserted good results; but in the 
opinion of the author this method is not the best for most cases, 
unless the nervous manifestations are very marked, when the chloral 
treatment may be of value. 

As a rule, the drug is easy of administration and well borne by the 
stomach. Its acrid after-taste is best masked by its administration in 
Aubergier's syrup of lactucarium, thus : 

I£— Chlorali hydrati gr. xxx (2.0). 

Svrup. lactucarii (Aubergier), 

Aquae dest aa fgss vel fgj (16.0-30.0).— M. 

S. — A teaspoonful (4.0) in iced water every two, three, or four hours, if pos- 
sible after food. 

The convulsions which sometimes usher in an attack are to be 
treated by 5-grain (0.3) doses of chloral and 10 to 20 grains (0.60-1.3) 
of bromide of sodium for a child of five to eight years. The convul- 
sions of the advanced stages are often ursemic, and must be treated 
accordingly. (See Uraemia.) 

From the very beginning of an attack to its end the child should 
always be supplied with plenty of pure water, and, if possible, this 
water should be obtained from a spring containing a low percentage 
of solids, as Poland water, which is widely sold throughout the United 
States. If this is impossible, then Celestin's Vichy water may be em- 
ployed, or an effect produced by obtaining the granulated Vichy salts 
sold by most large drug firms, and adding this in small amounts to pure 
filtered or distilled water. This makes an effervescing draught which 
may be taken while bubbling or not, as the child desires. The object 
of this treatment is to flush out the kidneys, and so to dilute the effete 
matters generated in the body by the fever and the germs of the disease 
that they lose, to a great extent at least, their poisonous and irritating 
powers. If the child is so young that it takes food from a nursing 
bottle, Poland water may be placed in the bottle. 

In other cases a prescription containing sweet spirit of nitre and 
citrate of potassium proves useful, as follows : 

^—Spt. aether, nitros. . ^ f 5j. (30.0). 

Potassii citratis . x 5ij (8.0). 

Aquae dest q. s. ad f §vj (180.0).— M. 

S. — Teaspoonful (4.0) every two hours if the urine is high-colored. 

The further treatment of the disease rests upon the symptoms alone. 
We cannot cure the patient by the use of remedies, but we can do 



SCARLET FEVER. • 737 

much toward making the pathway to health smooth and free from pit- 
falls and obstructions. 

Probably the most common complications calling for treatment, 
when the kidneys have been treated in the way just spoken of, are 
high temperature or fever, and sore throat or angina. The fever is to 
be controlled in these cases in precisely the same way that it is in all 
other conditions in which it is present. It is best to attempt to keep 
it below 101°, or at least below 102° F., by tepid sponging, which 
also allays the itching of the skin, or, if the temperature continues to 
rise, by the use of colder water. Generally the popular fear that the 
application of cold to the surface will drive the eruption "inward" is 
so strong as to make the cold sponging objectionable to the friends; 
but if the temperature reaches 105° F., the physician must assert the 
fallacy of this belief and insist on its use. (See Cold, Part III.) 
When the patient is overcome by toxaemia, the skin marbled and 
mottled, and the brain stuporous, he should be placed in a bath at 
100° F., and water at 60° or 70° F. poured on his head and shoulders 
with some force. In very young children the same effect may be 
obtained by dipping the patient alternately in hot and cool water. 
The object is to cause reaction and equalize the circulation. If sup- 
pression of the rash occurs, the wet pack must be used. (See 
Heat, Part III.) Antipyrin and acetanilid may both be used, but 
it is worthy of note that each of these may produce collapse or 
other complication if large doses are necessitated by an obstinately 
high temperature. If these complications ensue, alcohol will be indi- 
cated. Quinine has been highly recommended as an antipyretic in 
scarlet fever; but it is of little value in the majority of cases, simply 
disordering the stomach and irritating the kidneys if used in doses 
large enough to be effective. Where the head seems to be particularly 
hot and the fever is high an ice-bag or a head-coil of rubber tubing is 
to be employed, and through the latter water may be circulated at 
whatever temperature is thought best. (See Cold, Part III.) 

The treatment of the sore throat of scarlet fever is an important 
part of the care of the child in many cases. Small pellets of ice may 
be held in the mouth and an ice-bag applied to the outside of the 
throat. This is done by finely breaking some ice and placing it in 
a thin India-rubber bag about the neck, the surface of the bag being 
covered by a cloth to prevent too rapid melting of the ice and the wettir g 
of the clothes by the condensation of moisture on the surface of the 
bag. This treatment should be used during the entire attack if needed, 
and the contents of the bag renewed as often as the water becomes at 
all warm from the heat of the body. By this means the redness of the 
fauces and the swelling of the glands of the neck are relieved. Chlorate 
of potassium may be used in a spray or on a swab, but never internally 
owing to its irritant effects upon the kidneys and stomach and its 
general influence on the blood. When a false membrane forms, 
antidiphtheritic serum is to be given until a bacteriological examina- 



788 DISEASES. 

tion shows that it is not due to the Klebs-Loeffler bacillus. This 
membrane should be treated by applying peroxide of hydrogen. 

In cases where the eruption suddenly fades or is never well developed 
it is of the greatest importance that it be made active. Under these 
circumstances the child may be placed in the warm wet pack, and, if 
the head is very hot, cold applied to the vertex and throat while the 
body is enveloped in the blanket. (See Heat.) This often brings out 
in an hour or two a bright scarlet rash, and the child falls asleep and 
wakes up free from delirium and high fever. 

The itching and burning of the skin in many cases of scarlet fever 
are annoying symptoms, and they may become really dangerous. 
The author has carried out a series of experiments showing that 
fever of high degree can be brought on solely through nervous irrita- 
tion, thus explaining a fact long well known to clinicians — namely, 
that the relief of this dermal irritation in scarlet fever may be followed 
by a fall of temperature. To relieve this symptom it will often be 
found advisable to cover the entire skin with a thin layer of vaseline 
or cosmoline or benzoated lard; or, in other cases, as an antiseptic 
and local anaesthetic, phenolized oil may be applied (2 minims of 
phenol to each 2 ounces [0.1-60.0] of olive oil). In other cases 
almond oil should be used. 

If nephritis comes on and in a severe form, the greatest care is 
necessary, and the object of the physician must be to make the skin, 
disabled as it is, carry out sufficiently active eliminative function to 
relieve the kidneys of any strain, to remove dropsy, and to aid in the 
removal of effete matter by producing catharsis. Sweating may also 
be produced by the employment of heat obtained by the use of bottles 
of hot water or hot bricks placed about the patient, who is first wrapped 
in blankets, care being taken that the bottles do not burn the skin. 
The thermometer must be placed in the mouth to foretell any dan- 
ger from heat-stroke if the sweat should fail to appear. In such cases 
the hot pack is also of great value. (See Heat.) 

The after-treatment of scarlet fever during convalescence consists 
in the use of Basham's mixture or the tincture of the chloride of iron, 
and in the employment of simple bitters, strychnine, or quinine. 
Tresh air, sea-air or mountain-air is useful, while cold or exposure to 
cold air or draughts is to be carefully guarded against. 

SCIATICA. 

Sciatica is an exceedingly obstinate affection, in the many cases 
resisting the best treatment for weeks. It seems to be due to rheu- 
matic taint in the majority of instances, and may sometimes be cured 
by the remedies used and described under the headings of Acute 
or Chronic Rheumatism. In other instances it is due to injury or 
jarring of the nerve, as by heavy persons stepping off from a high 
step to the hard ground. Thus the most obstinate case ever seen by 



SCLERITIS. 739 

the writer was one in which a man weighing about two hundred 
and fifty pounds acted as " coupler " on a switching engine, and, 
though wonderfully agile for his weight, provoked the disease in the 
leg on which he always first struck the ground when jumping from 
the platform of the moving locomotive. 

The treatment for all cases is both internal and external. The 
internal treatment may be the same as that already described under 
Acute or Chronic Rheumatism, or in other instances consists in the 
use of large doses of bitartrate or citrate of potassium, 40 grains (2.6) 
three times a day, in plenty of water to aid in the maintenance of free 
kidney action. At the same time the amount of coffee and tea should 
be cut down as much as possible, and lemonade, with little sugar, 
be taken freely during the day. If the pain is excessive, morphine 
should be given, or antipyrin, citrophen, or acetanilid may be used. 
In some instances methylene blue in 5-grain (0.3) doses twice or 
thrice a day has seemed to relieve pain. (See Methylene Blue.) 

The local treatment of sciatica is quite various. One of the favorite 
methods is to inject deeply into the flesh, just over or about the exit 
of the nerve from the pelvis, 10 to 20 minims (0.60-1.3) of chloro- 
form, or instead of the chloroform \ to \ grain (0.01-0.015) of mor- 
phine, in 30 minims (2.0) of water which has first been distilled and 
sterilized, may be used with equally good results and less danger of 
sloughing. The pure chloroform is apt to cause an abscess. Other 
physicians prefer acupuncture, the needle being driven down until 
the sheath of the nerve is punctured. Still another useful method is to 
take a strong glass rod with a round, smooth end, and, after anointing 
the skin over the course of the nerve with a little ichthyol ointment or 
lard, to pass the end of the rod back and forth over the tender area, 
using as much pressure as can be borne. By this means massage or 
pressure on the nerve is accomplished. In other cases the daily use 
of an ether or rhigolene spray over the part is effective, or kataphoresis 
may be resorted to. In still others, from three to five large wet or dry 
cups, preferably the wet, may be placed along the course of the sciatic 
nerve with great advantage. In many cases absolute rest of the limb, 
obtained by placing it in splints, has to be adhered to before cure is 
possible. Hot-water bags should be placed continually about the 
exit of the sciatic nerve from the pelvis. 

The liniments recommended in chronic rheumatism may be tried, 
and cod-liver oil is of service in obstinate cases. Sometimes nerve- 
stretching must be performed before a cure is effected. 

SCLERITIS. 

Scleritis, or inflammation of the sclera, consists in a bluish-red, 
somewhat elevated patch, with implication of the overlying episcleral 
tissue (episcleritis). In the earlier stages pain and photophobia, if 
present, require atropine and boric acid and compresses of hot water; 



790 DISEASES. 

later, the infiltration may be subdued with yellow oxide of mercury 
ointment, associated with massage. If the disease spread and impli- 
cate the cornea and iris, the treatment useful in ordinary iritis is indi- 
cated. In stubborn episcleritis, without iritis, which does not yield 
to these measures, eserine, usually accompanied by pilocarpine sweats, 
should be tried, and even the actual cautery has been recommended. 
The disease in many instances is associated with rheumatism, syphilis, 
scrofula, anaemia, and menstrual disorders: these must always receive 
the needed constitutional treatment, especially if iritis or keratitis 
ensue. Scleritis is a disease difficult to eradicate and subject to 
frequent relapses. 

SCROFULOSIS. 

It is now universally recognized that scrofulosis is really a form of 
tuberculosis, yet, as its manifestations are often quite distinct, it is 
separately considered. 

Scrofulosis is to be treated by hygienic measures rather than drugs — 
fresh air, residence by the seaside, proper out-door exercise, massage, 
and dietetics, all of which take precedence of medicines. 

If these necessary adjuncts to a cure are obtainable, the prognosis 
is fair, to say the least, and the following drugs may be used, all of 
them being devoted to the improvement of the general health, and 
not to any direct influence over the scrofulous tendency in itself. It 
is hardly necessary to state that cod-liver oil is perhaps the best 
remedy of all. The oil should be given in emulsion, being first pan- 
creatized and so prepared as to be somewhat palatable by the addition 
of flavoring substances if the child is old enough to appreciate such 
flavors. In young children, while distaste of the oil is often shown at 
first, a liking for it rapidly develops, so that the writer has seen children 
cry for it when the oil was discontinued. In these cases it is nearly 
always best to combine the lactophosphates or the hypophosphites 
with the oil. When anaemia is present, syrup of the iodide of iron 
is useful in from 1- to 10-minim (0.05-0.60) doses, according to the age 
of the child, as follows : 

I$— Syrupi ferri iodidi f 5 ss velfSij (2.0-8.0). 

Aquae dest q. s. ad f §iij (90.0). — M. 

S. — Teaspoonful (4.0) in water three times a day, after meals, to a child of 
one year. 

In place of iodide of iron, yj-g- grain (0.0006) of arsenous trioxide 
or yutt grain (0.0006) of corrosive sublimate may be given to a child 
of three or four years, in the form of tablet triturates, or the follow- 
ing prescriptions may be used : 

1^ — Liquor potassii arsenitis TUxvj (1.0). 

Aquae destillat f gij (60.0).— M. 

S. — Teaspoonful (4.0) three times a day, after food for a child of five years. 



SCURVY. 791 

Or, 

I$— Hvdrarg. chlor. corros. . . gr. T V vel gr. £ (0.006-0.012). 

Aqua? desiillat f Sij (60.0) — M. 

S. — Teaspoont'ul (4.0) ever}' five hours, after food. 

The use of the iodides is generally contraindicated in those cases 
in which softening and breaking down of the glands are going on rap- 
idly. In their place calx sulphurata may be employed, given by placing 
1 grain (0.06) of it in half a tumblerful of water and giving a teaspoon- 
ful hourly. The mixture should be freshly made every day, to prevent 
its becoming oxidized. 

When enlargement of the cervical glands takes place, iodine oint- 
ment, diluted, one-half of lard, should be well rubbed into the part 
twice daily, but it should be stopped at once if signs of softening 
or fluctuation appear or if the skin becomes reddened. In cases in 
which these enlargements are persistent, ichthyol ointment is to be 
rubbed in, using the following formula : 

1^— Ichthyol 3ij vel 5iij (8.0-12.0). 

Adipis gj (30.0).— M. 

S. — Apply locally. 

If this is not followed by cure, the glands should be excised and the 
cavity packed with iodoform, as in the majority of cases these enlarge- 
ments will be found to be distinctly tuberculous. (See Adenitis.) 

SCURVY. 

The cure is so completely dependent upon the use of proper foods 
that almost no drugs are to be employed in the treatment of scurvy. 

The only remedies particularly indicated are orange- or lemon-juice 
or lime-juice or citric acid, the latter being far less valuable in all cases 
than the juice of the fresh fruit. Arsenic and iron are of service in 
most cases, and rest and quiet are to be insisted upon. 

By far the more common form of scurvy is seen in bottle-fed babies. 
The child may or may not have rhachitic manifestations. Generally 
it loses animation, becomes listless and peevish, evidently suffers pain 
in its body and limbs when it is lifted from the bed, and looks feeble 
and wan. The gums become spongy and swollen, and have an ecchy- 
motic appearance, and light blows produce bruises out of proportion 
to the severity of the injury. The treatment of infantile scurvy is a 
complete rearrangement of the child's diet-list,, and varying its food. 
No one baby food should be used to the exclusion of another, and 
sterilized milk is to be supplanted, if possible, by fresh new milk. It 
is important to remember that a large proportion of these cases occur 
in the children of the rich, who have subsisted largely on prepared 
"Infant Foods." Beef-juice squeezed from a half-cooked steak is 
useful. 



792 DISEASES. 



SHOCK. 



The medical treatment of shock is very important, and the life of 
the patient may depend upon the care exercised by the attendant; but 
before describing the treatment it is in place to consider the causes of 
the condition and the state of the injured person, so that we may 
understand the methods indicated. Every physiologist recognizes 
the fact that the body, particularly in its most vital parts, is controlled 
by inhibitory and accelerator nerves or nerve-cells, which govern the 
functions of all organs. Normally these two forces of inhibition and 
acceleration act in such a way as to be perfectly balanced, but abnor- 
mally they may either of them become excessive and overcome the 
other. Further than this, we must remember that all conditions of 
great functional activity are ultimately followed by a reaction which 
amounts to depression or exhaustion. 

Shock consists primarily in an overstimulation of the inhibitory 
apparatus which governs the heart and respiration, immediately fol- 
lowed by exhaustion of inhibition, so that the pulse and breathing 
become rapid and shallow instead of slow, and depression of the vaso- 
motor centre, so that a serious fall of arterial pressure ensues. Various 
degrees of shock can be readily recognized, and the severity of the 
condition depends upon the constitution of the individual and the 
character of the injury. Every one has heard a nervous woman say 
"You frightened me so that my heart stood still/' and again, a moment 
later, "Just feel how fast my heart is beating;" and we all of us know 
how any severe and sudden shock causes these changes to appear in 
the pulse to some degree. The same mechanism is the cause of great 
shock in railway or other injuries, only it is much more severe, owing 
to the actual injury received and its accompanying terrors. Many of 
the readers of this book probably know that a violent blow upon the 
belly-wall just over the solar plexus will cause death even in so large 
an animal as the ox, and every boy has had the "breath knocked out 
of him" by a blow in this region. 

This period of inhibitory excitement speedily gives place to inhib- 
itory exhaustion, and we have a rapid pulse not only from inhibitory 
palsy, but because the palsy of the vasomotor system relaxes the blood- 
vessels so that the normal resistance to the heart is removed. This 
vasomotor paralysis is the most important factor in the case. The 
heart beats wildly and fast for the same reason that a locomotive's 
wheels fly round when the track is slippery — or, in other words, nor- 
mal resistance is lost. 

The capillaries in this second stage of shock are dilated, and the 
patient may actually bleed to death into his own bloodvessels. The 
skin is relaxed, moist, and cold from excessive dissipation of heat. 
This is the more prolonged stage of the two, but they both need active 
treatment. 

The patient will rarely be seen in the first stage of shock, simply 



SMALLPOX. 793 

because by the time the physician reaches him the second stage will 
have come on. In either event the principal things to be done are 
the administration of -^ to 7 V grain (0.001-0.0012) of sulphate of 
atropine hypodermically, the injection of half a drachm of adrenalin 
chloride solution (1 : 1000) in 1 pint of hot salt solution into a vein, and 
the application of external heat to maintain the bodily temperature, 
the fall of which is a factor of great importance, but generally over- 
looked in attending to an operation or other measures of relief. The 
use of atropine and adrenalin are peculiarly triumphs of experimental 
therapeutics and rests upon logical deduction. It will be remem- 
bered that atropine in full dose acts as a depressant to the vagus nerve, 
and, as this nerve is overactive in the first stage, the drug acts as a 
sedative to it. This is, however, a comparatively unimportant fact, 
for it is another action of atropine which makes it valuable. If the 
vagus be greatly stimulated, a safe dose of atropine cannot quiet it; 
but in the second stage, which we most commonly have to treat, a safe 
dose does not act so much upon the vagus as upon the vasomotor centre, 
and it and the adrenalin, by preventing the dilatation of the blood- 
vessels of the body, thereby provide bloodvessels of normal tone and 
tenseness, which do not hold all the blood in stagnant pools where it is 
not needed, but carry it to the brain and vital parts. Digitalis is a 
useful adjuvant to atropine in the second stage of shock because of 
its powerful vasomotor and cardiac influence. Thirty drops (2.0) 
of digitalone should be given hypodermically, and repeated in an 
hour if the pulse does not show the influence of the drug at the end 
of that time. 

The application of heat in the form of hot-water cans, hot bricks 
or bottles, must not be forgotten, care being taken that the patient is 
not burned. (See Heat, Part III.) 

In many cases of surgical shock hypodermoclysis of hot saline 
solutions is of the greatest value, particularly if much blood has been 
lost. Its efficacy will be greatly increased if a drachm of a 1 : 1000 
solution of adrenalin chloride be added to it to stimulate the muscular 
coats of the bloodvessels, because the vasomotor centre may be so 
paralyzed as to have lost all control, for the time being, over the vessels. 
(See Hypodermoclysis, Part III.) 

SMALLPOX. 

The treatment of smallpox is not specific, simply because it is one 
of those diseases which run a given course and which cannot be aborted. 
We can only treat the various symptoms which present themselves, 
and by the modification of these manifestations prevent complications 
and sequelse to some extent. The fever is to be treated as is any fever 
of this class. Often it can be allayed by a mixture containing tincture 
of aconite, spirit of nitre, and spirit of Mindererus (liquor ammonii 
acetatis), while the headache or backache may be controlled by small 



794 DISEASES. 

doses of antipyrin or acetanilid. Mustard plasters are not to be used 
for the backache, as the dermal irritation will increase the eruption. 
Insomnia and restlessness, if excessive, are to be quieted by the bro- 
mides or chloral, care being taken that the doses of the latter are 
not large enough to depress the heart. It must be remembered that 
the time of onset of the secondary fever, the eighth day, is one of grave 
import to the patient. Before its arrival the treatment of the case 
must be so managed that strength is saved for this strain, and tincture 
of the chloride of iron, in 5- to 10- (0.3-0.60) or even 20-minim (1.3) 
doses, may be resorted to to give strength to the patient and to affect 
specifically the pysemic fever. The pulse should be watched, and if it 
flags brandy and whiskey should be freely but wisely used. At the 
same time nourishment in the shape of eggnog, milk punch, or beef 
tea should be given as freely as the digestion will allow. 

The peripheral irritation and itching of the eruption are a cause of 
the fever in part, and produce much unrest and nervous irritability. 
The condition of the skin is therefore to be looked after and pit- 
ting prevented, if possible, by every means in our power, particular 
care being taken to prevent its development on the face. One of the 
means which has been recommended to prevent pitting is the use of 
flexible collodion, and another application is glycerite of starch or 
simple cerate applied in a heavy coating. Some physicians recom- 
mend inserting the tip of a nitrate of silver stick into each vesicle as it 
ruptures, to prevent pitting. All of these measures are futile in most 
cases, and the use of collodion is probably harmful in some instances. 
The best application to use is made of 4 parts of salicylic acid to 100 
parts of vaseline or cold cream. Sometimes, anointing the entire body 
with sweet oil slightly phenolized (1 : 100) is useful to check irritation. 

If the mouth is sore, a mouth-wash of chlorate of potassium and 
water may be used, flavored with a little tincture of myrrh. (See 
Chlorate of Potassium.) 

Disinfection, good ventilation, and the avoidance of much light are 
necessary. 

STINGS AND BITES. 

The stings of nearly all small insects depend for their activity upon 
formic acid, and are to be relieved by the use of dilute alkaline liquids, 
or, better still, by the application of ammonia, or, instead, an applica- 
tion of ordinary or flexible collodion may be made, or water of 
witch-hazel, which is improved in its action by the addition of 1 
part of mercury bichloride to 1000 of the collodion, or, if preferred, 
salicylic acid may be added in the proportion of 5 grains to the ounce 
(0.3-30.0). Sometimes a solution of phenol, 1:100 or 1:50, when 
sponged over the parts exposed, not only relieves the itching of 
mosquito-bites, but also repels the mosquitoes. In other instances the 
stings are relieved and cooled by the use of dilute or pure vinegar. 



STOMATITIS. 795 

A useful application to prevent mosquitoes from biting is : 

I$— Olei citronellse . . . . . . ■ . . f'5j (4.0). 

Alcohol 1'oj (4.0).— M. 

S. — Apply freely to the skin exposed. 

In snake-bite the best treatment consists in sucking the wound, as 
snake-venom, even if swallowed, is not very poisonous. The part 
should then be freely incised, so as to cause the blood to flow freely, 
and immediately the wound should be filled with permanganate of 
potassium, and full doses of this drug given hypodermically about the 
wound, the salt being diluted three-fourths with water, and followed by 
full doses of alcohol or ammonia by the mouth. The secret of success- 
ful treatment consists, however, in the use of a ligature above the bitten 
spot and the opening of the wound as soon after its reception as pos- 
sible, thereby preventing absorption of the poison. Antivenine and 
other antitoxins promise much for treatment in the future. 

STOMATITIS. 

This annoying affection is most commonly seen in children, and is 
characterized by the appearance on the tip and sides of the tongue, 
lips, and lining membrane of the mouth of small spots which some- 
times have a reddened zone around them, and which result in minute 
or large ulcers. 

The best treatment, if the kidneys are not acutely inflamed, is the 
use of the following prescription, which largely depends for its value 
upon the potassium salt used : 

!£y — Potassii chlorat 5j (4.0). 

Tinct. myrrh. gtt. xx (1.3). 

Elixir calisayse fgiij (90.0).— M. 

S. — Teaspoonful in water every four hours. 

As the chlorate of potassium is eliminated with the saliva, it not only 
does good when taken into the mouth, but is also active all the time 
that it is being eliminated. If the stomach is disordered, the same 
preparation may be used as a mouth-wash. Often constipation is 
present, and it should be relieved by salines or by rhubarb in the form 
of the aromatic syrup. Another remedy which is very efficient in 
stomatitis is borax, used as a mouth-wash, in the strength of 10 to 15 
grains to 1 ounce (0.60-1.0: 30.0) of water and honey, as follows: 

1^ — Sodii boratis gr. xxx (2.0). 

Mel. depurati f 3 iij (12.0). 

Aquse destil q. s. ad f 5iij (90.0). — M. 

S. — To be used on a swab or as a mouth-wash every four hours. 

This also may be given internally to adults in the dose of a teaspoonful 
(4.0) every three hours. 

In many cases peroxide of hydrogen in the proportion of 1 ounce 
(30.0) to 8 ounces (240.0) of water proves a valuable mouth-wash. 



796 DISEASES. 

If the liver is at fault and is torpid, nitromuriatic acid is useful; and 
when the spots do not readily yield to treatment they may be touched 
with the tip of a stick of silver nitrate, which treatment, while it is 
momentarily painful, is very efficacious. 

Nearly always with this disease in childhood there is considerable 
fever, vomiting, and wakefulness at night, with fretfulness and crying 
during the day, and total refusal of food, not because hunger is absent, 
but because the food hurts the mouth and is rejected with a cry of 
pain as soon as it touches the lips. The food should be very soft milk- 
toast for older children, or milk with lime-water in it in large amount 
for infants fed by the bottle. If a child at the breast be attacked, the 
mother's nipple should be carefully washed with boric-acid solution 
after each nursing. A warm foot-bath at night is often necessary to 
produce rest, and 10 minims (0.60) of sweet spirit of nitre thoroughly 
diluted may be given with advantage to a child of one or two years. 
If the irritability of the nervous system is excessive, bromide of sodium 
or potassium in the dose of from 1 to 10 grains (0.06-0.60), according to 
age, three times a day, is of service, and may be added to the mixtures 
already named, or, better still, given alone, well diluted with syrup and 
water. 

After the attack tonics and a carefully selected diet are generally 
necessary. 

STYES. 

Styes consist in a localized inflammation of one of the glands in 
the margin of the lid or the surrounding connective tissue. Before 
suppuration is established, abortive treatment may be practised by 
inunction with a salve of the red or yellow oxide of mercury (2 grains 
to 1 ounce [0.12-30.0]), by painting the surface with an ethereal solu- 
tion of collodion, or, according to Abadie, by the application of a satu- 
rated solution of boric acid. Pain may be alleviated with hot com- 
presses (water 110° F.), frequently changed; but as soon as pus appears 
incision is necessary. Associated conjunctivitis requires a boric-acid 
solution for its relief. It should be remembered that styes indicate 
ill health, that tonics are indicated, and that they most frequently 
appear in subjects with refractive error. When they tend to recur in 
crops the internal use of sulphurate of calcium has been recommended. 



SUNSTROKE. 

Sunstroke — or, more correctly speaking, heat-stroke — is an affec- 
tion produced by exposure of the body to any form of high temperature, 
whether the source of heat be the sun, a furnace, or the radiation of 
heat from the earth. For this reason the condition may occur as 
readily at midnight as at mid-day. 

Heat-stroke is to be divided into two classes, in one of which excessive 
exposure to heat upsets the balance of the thermal mechanism of the 






SUNSTROKE. 797 

body, so that fever (thermic fever) comes on ; in the other the tempera- 
ture is lowered and forms the condition known as heat-exhaustion. 

The condition of thermic fever is very frequently seen, while heat- 
exhaustion is rare. 

The treatment of these two states is, of course, radically different. 
When a patient has thermic fever and comes under the care of 
the physician, the first thing to be done is to loosen the clothing — if 
possible, remove it — and if the pulse be bounding, the face cyanotic, 
and the heart laboring, to bleed him freely. At the same time intra- 
venous injection of normal salt solution should be freely resorted to, 
and this is particularly needful if the blood flows slowly and is very 
dark in hue. (See Intravenous Injection.) At the same time cold 
should be applied to the body, and particularly to the head, abdomen, 
back, and chest. The man should be stripped, laid upon a bed, 
which must be covered with a rubber blanket, and ice-water applied 
to the body by means of a sponge, or a piece of ice may be laid on the 
head, while another piece is rubbed over the rest of the body. While 
this is being done the surface of the patient's body must be thoroughly 
and briskly rubbed in order to bring the hot blood to the cooled skin. 

Care should be taken that the temperature, when it once begins to 
fall, does not drop suddenly below the normal and cause collapse. 
If the clinical thermometer in the mouth or rectum shows that the 
temperature has fallen to 101.5° or 100° F., the cold application 
should be stopped, and the patient allowed to lie on a bed, covered 
only with a thin sheet. The bodily temperature must be constantly 
watched, as it will probably bound up again in a few minutes, and 
require the application of more cold, used with the same care. This 
second rise is due either to the disorder of the nervous mechanism of 
heat-production and dissipation, or to the fact that, while the surface 
of the body is cooled by the ice, the innermost viscera are still in high 
fever and rapidly heat the surface as soon as the ice is taken away. 
Antipyretics have been found to be almost useless in the hyperpyrexia 
of sunstroke, and are not to be relied upon. 

After the fever has been reduced permanently the danger is not all 
passed, and it is the greatest mistake to discharge a patient as cured 
at this time. After two or three days it is very common for a menin- 
gitis to develop, accompanied, it may be, by little or no fever, but 
characterized by violent darting headache, which is made worse on 
lying down or on sudden movement. The treatment of this state 
must be bold, and venesection is the only safe method of obtaining 
relief, although vascular sedatives, such as veratrum, may be employed. 
The bleeding should be copious enough to impress the circulatory 
system to some degree, and may be done by opening any of the 
prominent veins in the arm. (See Venesection.) Sometimes a vio- 
lent attack of epistaxis saves the man's life when it would have 
been lost through the ignorance of his attendant. If life is preserved 
without vascular depletion, secondary changes in the brain may ensue 



798 DISEASES. 

and produce hemianopsia, optic atrophy, imbecility, or insanity. 
Quinine, salicylic acid, and similar substances are all contraindicated 
under these circumstances, because of the congestion of the meninges 
to which they predispose by their physiological effects. 

The treatment of heat-exhaustion consists in the use of heat instead 
of cold, in order to restore the bodily temperature. Just here, how- 
ever, must be uttered a word of warning — namely, that the mere fact 
that the skin is cold does not prove the case to be one of heat-exhaus- 
tion, since a rectal thermometer may show the central or real tem- 
perature of the body to be that of hyperpyrexia. Of course, such a 
case should not receive hot, but cold, rectal injections if the symptoms 
require it. 

The bodily heat in heat-exhaustion is to be raised by placing the 
patient in a bath at 105° to 110° F., or by the use of hot bricks or bottles, 
care being taken that they do not burn the patient. The bodily tem- 
perature should also be watched, lest the other extreme of heat be 
reached. 

Cases of heat-exhaustion are not so apt to have meningitis as are 
cases of sunstroke, but they are generally slow to convalesce, and 
require tonics and careful watching for a long time. Indeed, in many 
instances the system seems to receive a shock from which it takes 
several weeks or months to recover. 



SYPHILIS. 

In so far as the choice of drugs is concerned, the treatment of syphilis 
is exceedingly simple: iodine, iodide of potassium, and mercury 
practically represent the only remedial agents which are well proved 
to possess the power of distinctly counteracting the effects of the dis- 
ease. 

In regard to the method of administration and the period of the 
disease in which any or all of these drugs can be given to the best 
advantage there is a wide diversity of opinion. Following the teach- 
ing of Fournier, in the United States the practice generally obtains of 
administering mercury on the appearance of the first symptoms of 
the secondary stage of syphilis; this drug is continued for from twelve 
to eighteen months, and is then followed by a course of iodide of 
potassium continued for from six to twelve months. If after the sus- 
pension of this treatment for six months no manifestations of disease 
appear, the patient is regarded as cured. Should the disease again 
break out, the iodides are administered in increasing doses, supple- 
mented by the addition of mercury if necessary. 

Against this treatment, however, there have been many and vigor- 
ous protests. Every syphilographer knows that the disease is fre- 
quently self-limited. Zeissl states that a large number of cases progress 
to spontaneous cure, and that the secondary eruption in such cases 
disappears in from two to eight months, after which time the patient 



SYPHILIS. 799 

is perfectly well, recidivity being far less common than when mercury 
has been employed in the early stages of the disease. The treatment 
by iodides, he thinks, should be commended chiefly after the expectant 
plan: their effect is not so rapid as is that of mercury; they are suitable, 
however, to all stages of the disease. When the symptoms become so 
urgent that it is no longer safe to depend upon iodides, mercurial 
inunctions should be employed, the dosage of the drug being regulated 
by its effect upon the symptoms, in all cases the minimum quantity 
necessary to accomplish the result being administered. 

We have, then, three methods of treatment proposed, each advo- 
cated by a formidable array of authorities: 

1. The expectant treatment. 

2. The treatment by iodides, followed, if necessary, by mercury. 

3. The continued treatment, beginning with mercury and ending 
with iodides or the combination of the two drugs. 

By the expectant treatment is implied abstinence from all medication 
intended to counteract directly the syphilitic virus: if possible the 
patient should lead an active, out-of-door life, the diet should be most 
carefully regulated, and the treatment should be purely symptomatic, 
tonics being administered when required, the sore throat being com- 
bated by astringent gargles, particularly those containing chlorate of 
potassium or malic acid, together with direct local applications, while 
the eruption on the exposed parts of the body is controlled by the 
application of heat. Even in the mildest cases there is nothing to be 
said in favor of this treatment. W T here the primary lesion is large and 
persistent; where the period of secondary incubation is less than 
seven weeks; where the papular eruption is universal, is confluent, 
and is accompanied by the simultaneous appearance of mucous 
patches; where the lymphatic enlargement is marked and persistent; 
and where the disease attacks a subject with depraved constitu- 
tion, the expectant plan offers little hope of accomplishing a cure. 
Here the second and third methods of treatment are absolutely indi- 
cated. 

By the second plan of treatment the iodides are administered, not 
immediately on the appearance of the secondary eruption, but after 
this has run a course of several weeks and is steadily increasing in 
severity. The iodide of potassium is chosen by preference, beginning 
with the administration of 5 grains (0.3) three times a day, and increas- 
ing steadily 5 grains (0.3) a day until either the constitutional effects 
of the drug are manifested or the symptoms are favorably influenced. 
Should iodism appear, the dose is cut down one-half and continued 
for one or two weeks, after which time, if the syphilitic lesions are not 
favorably modified, inunctions of mercury are employed, a drachm (4.0) 
of mercurial ointment being rubbed in every other day. The iodide 
should be continued for from six to twelve months after the disappear- 
ance of all symptoms, relapses being combated by temporarily increas- 
ing the dose and by a course of mercurial inunctions. If after the 



800 DISEASES. 

suspension of the treatment the patient remains free from all mani- 
festations of syphilis for two years, he can be fairly considered as 
cured. 

By the third method of treatment — and this is the method most 
commonly accepted in practice — the patient is placed upon mercury 
the moment the early secondary symptoms denote that the primary 
sore was surely syphilitic. Many surgeons begin this treatment from 
the time that the inguinal glands on both sides become characteristic 
in shape and size. Others wait until there is general lymphatic 
involvement, while others believe that the mercury should not be 
administered until roseola appears. 

In regard to the particular preparations of mercury to be employed, 
the protiodide, blue mass, bichloride, and mercury with chalk repre- 
sent the forms usually employed when the drug is administered by the 
stomach. Of these the protiodide is to be preferred, and the effort of 
the surgeon is directed first toward determining what is termed the 
"tonic" dose. With this end in view, \ grain (0.015) of the protiodide 
of mercury is given, in pill form, three times a day, and every second 
day this quantity is increased by one pill, the patient being mean- 
while carefully watched. The drug usually manifests its physiological 
effects by griping pains accompanied by two or more watery passages 
from the bowels, or by fetid breath and slight tenderness of the gums. 
The quantity taken to produce this effect represents the extreme limit 
to which it is safe to push the drug. If this dose is continued or 
increased, the characteristic symptoms of mercuric saturation appear. 
When the surgeon has determined the limit to which the drug can be 
safely pushed, this dose is cut down one-half, and in the absence of 
further complications the patient is directed to continue with this dose 
for eighteen months. If during this time local symptoms appear 
which show that the disease is not thoroughly under control, the 
mercury must again be pushed to the full dose, being reduced to the 
tonic dose as soon as the disappearance of specific lesions permits. 
Where comparatively small doses of the protiodide produce pain and 
purging, opium may be added; in this case the breath and the mouth 
will show when the full effect of the medicine is obtained. Manifesta- 
tions of the disease occurring during mercuric treatment must receive 
local treatment. The surface eruption is combated by mercuric 
ointments and washes and by the application of heat. (See Heat.) 
Mucous patches in the mouth are quickly healed by applications of 
solid nitrate of silver or sulphate of copper, 20 per cent, chromic acid 
solution, or the acid nitrate of mercury. When these patches occur 
about the genitals, washing with 1 : 2000 bichloride solution and dust- 
ing with calomel and bismuth will be found satisfactory. Alopecia is 
combated by shampooing and by the application of strong stimulating 
lotions containing croton oil or tincture of cantharides. 

The intense cephalalgia is combated by J-grain (0.010) doses of 
calomel, repeated every two hours. The periostitis yields most readily 



SYPHILIS. 801 

to gentle, long-continued mercuric inunction, supplemented by the 
application of pressure bandages. 

When the integrity of any vital organ is threatened there should be 
no hesitation in pushing the mercury treatment, and in supplementing 
it, if favorable results do not follow promptly, by large doses of iodide 
of potassium. 

After the first eighteen months iodide of potassium is generally indi- 
cated. This is commonly given together with the mercury, consti- 
tuting the mixed treatment. The following formula, or one similar 
to it, may be employed: 

I>— Potassii iodidi oij vel 5iv (8.0-16.0). 

Hydrarg. chlor. corros. ... gr. ss (0.03). 

Syrup, aurant. cort foj (30.0). 

Aquae destil. . . . q. s ad f §ij (60.0).— M. 

S. — Teaspoonful (4.0) three times a day. 

When this prescription is put up a precipitate is formed and then dis- 
solved. 

This mixture, or iodide of potassium without the mercury, admin- 
istered in 5- to 10-grain (0.3-0.60) doses three times a day, is given 
for from six to twelve months longer. When the iodide is given alone 
it is most conveniently administered in the form of a saturated solution. 
Of this a drop contains a grain of the salt. Milk seems to have the 
power of completely disguising the disagreeable taste of the drug. 
Thereafter, specific treatment is stopped, unless symptoms arise, in 
which case it should be renewed and should be continued for many 
months. 

The protiodide is usually preferred, because the symptoms of its 
constitutional effect are manifest at first by looseness of the bowels, 
and because in practice it has been found one of the most satisfactory 
of all preparations. Where this form of mercury is not well borne the 
physician should at once employ some other salt; the bichloride, in 
T V-grain (0.005) doses three times a day, is efficacious. Blue mass 
will often act favorably when other preparations cannot be tolerated. 
Its combination with iron is desirable, and the following formula repre- 
sents one of the most valuable of the antisyphilitic pills: 

R — Mass. hydrargyri gr. xxx (2.0). 

Pulv. ferri chloridi gr. xv (1.0). — M. 

Ft. in pil. Xo. xii. 

S. — One three times a day. 

Where mercury cannot be administered by the mouth it may be given 
by means of vapor-baths, by inunctions, and by hypodermic injections. 
The vapor-baths are useful when it is desired to cure promptly erup- 
tions on the surface of the body or when it is most important to bring 
the disease quickly under the influence of mercury. They are readily 
administered, the only apparatus required being an alcohol lamp and 
a plate on which the mercury preparation can be volatilized. The 

51 



802 DISEASES. 

patient is seated in a chair entirely naked ; several blankets are wrapped 
around his neck, and beneath the tent thus formed a large vessel of 
steaming water is placed. When the skin is thoroughly softened J 
drachm (2.0) of calomel is sublimed by means of the lamp. These 
baths may be repeated every night until fetor of the breath is observed 
or until the specific symptoms disappear. (See articles on Mercury 
and on Heat.) 

Inunction represents the most efficient way of administering the 
mercury treatment. When the stomach is intolerant of drugs, or 
when, administered by the mouth in full doses, they do not favorably 
modify the symptoms, inunctions are indicated. The patient is 
instructed to take a warm bath, and the mercury is then well rubbed 
in over the inner surface of the forearm and arm and along the side 
of the chest for fifteen minutes. Either the oleate of mercury, 10 per 
cent., or the ordinary mercury ointment is commonly employed; the 
former is more cleanly, but less efficient. The rubbings should be 
done by the patient, should be made over a large surface of the body, 
and should be performed thoroughly; 1 drachm (4.0) of blue oint- 
ment is rubbed in daily. A shirt kept for this purpose is then put 
on next the skin and the ordinary clothing is worn over this. The 
next night the opposite arm and side of the body are utilized as the 
seat of inunction; the following night the right groin and the inner 
surface of the right thigh and leg; next, the same regions of the opposite 
side of the body; finally, the anterior surface of the chest and abdomen. 
In this way irritation of the skin is avoided. Where it is impossible 
to employ the inunctions in this way, another means of causing absorp- 
tion of mercury through the skin, suggested by Sturgis, will be found 
satisfactory: After a thorough soaking of the patient's feet in hot 
water, from J to 1 drachm (2.0-4.0) of a 20 per cent, oleate of mercury 
is rubbed vigorously into the sole of one foot; the next night the sole 
of the other foot is treated in the same way. The patient is directed 
to wear, night and day, a pair of woollen socks; these are not changed 
for one week. Mercury may be taken by the mouth at the same time 
inunctions are employed when it is desired to influence the system 
quickly. In the late periods of the disease very striking effects are 
often obtained by supplementing the iodide treatment by a course of 
twelve to eighteen inunctions. 

In the United States the hypodermic administration of mercury is 
limited to those few cases which do not seem to respond to the drug 
when given by the month or by inunction. Although many prepara- 
tions of mercury have been lauded as most efficacious when used hypo- 
dermically, the best formula seems to be that recommended by Hebra. 
This consists of a solution of 1 per cent, of bichloride of mercury in a 
6 per cent, sodium chloride solution; the resulting mixture is per- 
fectly clear and is readily prepared. If it becomes turbid, it should 
be thrown away. Most rigid antiseptic precautions must be observed, 
as abscess-formation is not uncommon. One injection is given daily, 



TONSILLITIS. 803 

J to J grain (0.01-0.02) of the sublimate being administered. 
The nates are selected as the seat of the injection, the solution being 
driven well into the muscles of each side every other day. Twenty 
injections are usually sufficient to cause the disappearance of all symp- 
toms. The employment of the insoluble preparations of mercury, 
particularly of calomel, gives much pain, frequently causes abscess, 
and is at times attended by a continuous absorption which may pro- 
duce severe and even fatal ptyalism. 

The ulcerations often found as tertiary manifestations of syphilis 
are treated according to general surgical principles. The local appli- 
cation of mercury preparations is of less service than during the 
existence of the secondary lesions. Iodoform is peculiarly serviceable. 

The tonic and general treatment of syphilitic cases must not be for- 
gotten; fresh air, exercise, bathing, careful diet, regular living, all 
must be enjoined. Moreover, in certain cases where there is marked 
anaemia or physical weakness cod-liver oil, stimulants in moderation, 
compound syrup of the hypophosphites, and other tonic and nutritive 
courses of treatment must be carefully administered. 

Although the treatment of an ordinary case of syphilis is simple and 
satisfactory in its results, it must be remembered that there are malig- 
nant forms of the disease, attacking by preference feeble and cachectic 
individuals, running a rapid and virulent course, unchecked, nay 
aggravated, by specific treatment, and responding feebly, if at all, to 
the most careful hygienic and tonic regimen. In such cases a strong 
extract of sarsaparilla is sometimes of service. 



TETANUS. 

The treatment of tetanus after the symptoms have developed is quite 
independent of its causation, so far at least as drugs are concerned, 
and is virtually identical with that of strychnine-poisoning, to which 
the reader is referred. (See Nux Vomica.) It is stated that Fowler's 
solution acts almost as a specific in some cases. The value of the anti- 
toxin for tetanus depends very largely upon how early it is given. 
When the disease has once developed, it cannot be of much use, but it 
should always be tried. (See Antitoxin, Part III.) The diet should 
be most nourishing. Continuous immersion in hot water may be 
tried. 

TONSILLITIS. 

Inflammation of the tonsils occurs in three forms: superficial ton- 
sillitis, in which the mucous membrane covering the tonsils becomes 
inflamed through extension of a pharyngitis; follicular tonsillitis, in 
which the follicles are chiefly involved and pour out an excessive 
secretion; and, finally, true tonsillitis, in which the gland itself suffers 
from severe, widespread inflammation phlegmonous in type. In all 
these forms the treatment to be instituted at the beginning is prac- 



804 DISEASES. 

tically identical. The bowels should be opened by a saline purgative, 
which in some cases should be preceded by small doses of calomel, 
the diet should be liquid and nutritious, and a fever and diuretic mix- 
ture should be given freely as follows: 

I$— Tinct. aconiti n\xl vel lxxx (2.0-5.3). 

Spt. setheris nitros foj (30.0). 

Liq. potassii citratis . . q. s. ad f Biij (90.0). — M. 
S. — Dessertspoonful every three hours to a child of ten years; or a tablespoon- 
ful (2.0) to an adult. 

The best local treatment is to paint the tonsil with pure guaiacol on 
a cotton applicator, or a solution of nitrate of silver may be used, 
60 grains to the ounce (4.0-30.0), applied with a camel's-hair brush. 
Externally, an ice-bag should be applied about the throat, and as 
soon as the purgative has acted and the fever is reduced by the mixture 
just given, full doses of the tincture of the chloride of iron should be 
administered (20 minims [1.3] every three or four hours), in plenty of 
water, which preferably should be Vichy or one of the good lithia 
waters. 

Small doses of biniodide of mercury are sometimes useful to abort 
an attack of acute tonsillitis, -jto - grain (0.0003) every hour in water 
for four or five hours being the amount usually employed. 

In some instances hot fomentations about the neck and hot gargles 
seem to be more beneficial than the use of ice. Often a mild antiseptic 
gargle of phenol (1: 100 of water will relieve the pain and the fetor 
of the breath. 

Finally, it should be remembered that rheumatic persons suffer 
severely at times from tonsillitis, and the best remedies for this form of 
tonsillitis are the salicylates or guaiac. 

TUBERCULOSIS. 

Tuberculosis affecting any part of the body is a manifestation of the 
fact that vital resistance has been decreased, for if not infection could 
not have taken place. The whole point at issue in cases of tubercular 
infection is the building up of vital resistance to such a level that the 
battle between the invading bacillus and the cells of the body can be 
waged with victory for the cells, and as soon as they are able to cope 
with the infecting agent there is at once formed a protecting wall of 
inflammatory lymph which surrounds the area infected and protects 
the rest of the body from the bacilli that it contains. The means by 
which the greatest degree of vital resistance are obtainable is an out- 
door life with exposure to as many hours of sunshine as possible and 
an abundance of fresh air. No drugs can equal the value of these out- 
door agencies. (See Climate, Part III.) 

The second point to be borne in mind is that no drugs in tuberculosis 
equal good food if it is well digested and , taken in full amount, and he 
who disorders the digestion by drugs is doing his patient more harm 



TUBERCULOSIS. 805 

than good. A good cook is a better friend to a tuberculous patient 
than a good druggist. (See Diet, Part III.) 

Cases of pulmonary consumption follow, rudely speaking, four 
well-defined lines. A very early stage sometimes comes to the care 
of the physician, and it is that in which the following history is given 
or a similar story is elicited. A patient, previously strong and well 
or of poor health, as the case may be, begins to lose vivacity. Life 
becomes a burden and exercise is distasteful. A slight daily chill and 
fever develop in morning or evening, and the physician who is careless 
treats the case as one of mild malarial poisoning. Careful examina- 
tion, however, will show an area in the lung, generally near the apex 
on one or both sides, where slight prolongation of expiration with a 
harsh inspiratory sound is heard, and where percussion will give 
impaired resonance or dulness. In other words, the first stage of 
phthisis is present, and the physician must resort at once to those 
active measures for the patient's relief which will be considered 
shortly. 

In another form a chill, a sweat, a loss of flesh and vigor, with, 
more prominent than all, a hard cough, sudden in its onset and rap- 
idly becoming excessive with profuse expectoration, are the dominant 
symptoms. The wasting is extreme, the sweats are constant, and 
death may come in a few weeks. This is the form known as 
" galloping consumption." 

The third variety is ushered in by a gradual loss of vigor or a sensa- 
tion of being a little unwell, or this form is brought before the patient's 
mind by a sudden acute hemorrhage, or several hemorrhages rapidly 
succeeding one another. This variety passes along its course with 
varying rapidity. Death now is due directly to the hemorrhage, 
although a secondary pneumonia may bring the end. In most cases 
the disease keeps on for months and the case dies from exhaustion. 

Last of all, the fourth class is made up of persons who gradually 
pass from bad to worse: First, they "catch a cold," which hangs on 
longer than it ought, and, as soon as they are well, this is followed by 
another one, which is found more difficult to cure, until finally there 
is always a cough. Soon wasting comes on, strength is lost, and a 
long period of months ensues during which the progress of the case is 
now slow, now fast, the condition now better, now worse, until death 
ensues from wasting, pneumonia, or some other complication. 

These forms and stages have been roughly outlined so that a dis- 
cussion of their treatment might be taken up with a clear idea of what 
is to be done. 

When a patient exhibits those physical signs which have been 
given as evidences of the early beginnings of phthisis, the physician 
should institute certain hygienic and medicinal measures. If the 
individual be earning a livelihood by following some confining occu- 
pation, this occupation must be given up and one undertaken which 
is carried on in the open air and yet not accompanied by too great 



806 DISEASES. 

exposure. Even if exposure is incurred, it is often better than the 
occupation previously followed : thus, if the patient be a bookkeeper, 
a printer, or a bookbinder, or a clerk kept much at a desk in an ill- 
ventilated room, a few wettings in the rain will do little or no harm 
if the patient is properly protected by the wearing of flannel shirts, 
which, when wet, are changed as soon as labor ceases, as under these 
circumstances the danger of catching cold is at a minimum. (See 
Climate, Part III.) 

The medicinal measures to be carried out in all cases of phthisis, 
except that known as the galloping form, are not numerous if we con- 
tine ourselves to the modes possessing any real value. For many 
years cod-liver oil has been sadly abused in the management of these 
cases, and has been given at all stages, owing to ignorance of its proper 
use. The writer believes that the following rules are never to be 
departed from: 

1. Never use cod-liver oil if it disturbs digestion. 

2. Never use it if fever is active. 

3. The use of cod-liver oil when rapid degenerative changes are 
occurring in the lung may be distinctly harmful, as it is not of any 
service, disorders the digestion, and destroys the appetite. 

4. Its best employment is in the earliest stages of the disease and in 
chronic fibroid phthisis. 

When the oil is used, it should be given as directed in the article on 
Cod-liver Oil. 

A remedy of some value as a palliative is creosote. Many cures 
have been claimed from its use in the early stages of phthisis, and 
it has been highly lauded by a number of European clinicians. In 
the author's experience it is of value only when the presence of 
bronchitis requires the use of an expectorant. If it disorders digestion, 
it is harmful. The opinion declared by Striimpell expresses so well 
the thought which the author was about to write when he read 
Strumpell's article that his words are here given: " Taking it all in all, 
we find that creosote, even in large doses, has no injurious effect on 
tuberculosis. At times we notice an apparently favorable symptomatic 
effect. We failed, however, to observe any real influence exerted by 
creosote on the progress of the disease." (See Creosote.) 

When creosote is used internally it may be given in the following 
formula : 

I£ — Creosoti (beechwood) gtt. xxxij vel foj (2.0-4.0). 

Tr gentian f 3j (4.0). 

Alcoholis foj (30.0). 

Vin. albi q. s. ad f§iv (120.0).— M. 

S. — Teaspoonful (4.0), in water or wine, three times a day. 

Better still, it may be given in ascending doses (1 minim extra each 
dose) in milk or wine. 

Often a 1-minim (0.05) dose three times a day may be increased to 
5 minims (0.3) in the same period with advantage. Sometimes 1 or 2 



TUBERCULOSIS. 807 

minims (0.05-0.1) in capsule are as useful as the formula just named. 
(For methods of administration see Creosote; also, see Guaiacol and 
Creosote Carbonate.) 

Creosote may also be inhaled in the spray from a steam atomizer or 
by means of an inspirator fitted over the nose and mouth and made of 
perforated zinc with a sponge at the edge to hold the drug. A very 
good method is to wet the sponge with creosote, alcohol, and water, 
equal parts, or to use the creosote alone if coughing is not too severe. 
Another useful mixture consists of equal parts of terebene, iodide of 
ethyl, and chloroform. This last mixture is most useful when the 
secretion is tough and tenacious, and should not be used in the pres- 
ence of acute irritation due to inflammation. Such inhalers are very 
cheap, not easily broken, and readily worn. (See Inhalations.) 

If the cough is excessive, a little spirit of chloroform placed on 
the sponge of the inhaler will often relieve it, or a mixture of mor- 
phine and wild-cherry bark may be given as follows : 

1$ — Morphinae sulph gr. j vel ij (0.06-0.12). 

Syr. pruni Virginianae f oiij (90.0). — M. 

S. — Teaspoonful (4.0) every- three hours 

Or the following: 

I$_Spt. chloroformi f|ss(16.0). 

Morphinae sulph gr. j vel ij (0.06-0.12). 

Syr. pruni Virginianse f^iij (90.0). — M. 

S. — Teaspoonful (4.0) even- four hours. 

In still other cases 2 to 10 minims (0.1-0.60) of a good fluid extract 
of cannabis indica, or \ to \ grain (0.008-0.015) of the solid extract, 
will act with surprising benefit and stop the cough. Heroin in small 
doses is also useful when there is an idiosyncrasy to morphine. 

Very often during the course of phthisis localized spots of pleuritic 
inflammation develop which give rise to pain. The best treatment is 
to apply a small blister or to paint the spot with iodine. 

(For the treatment of Haemoptysis see Hemorrhage.) 

Laryngeal phthisis, one of the most serious complications of this 
disease, is best prevented by ordering the patient to inhale the steam 
arising from boiling water which contains corrosive sublimate in the 
proportion of 1 : 10,000. If a proper watch is kept for evidences of 
a general mercurial effect, and this measure stopped at once when 
tenderness of the gums appears, no danger exists. Before the inhala- 
tion takes place a spray of cocaine (4 per cent, solution) should be 
thoroughly used. 

The treatment of laryngeal phthisis itself is various. The best 
method is that in which lactic acid is used. By the aid of a laryngeal 
mirror and a cotton applicator a 10 per cent, solution of lactic acid is 
applied to the spots which are involved. As this is generally quite 
painful, cocaine solution should first be used. Gradually the strength 
of the lactic-acid solution should be increased to 60 per cent, if the 



808 DISEASES. 

weaker solutions do not check the disease. Very valuable results 
have been obtained by this method. 

The second method in point of value is that of iodoform insuffla- 
tions. A powder of iodoform alone is too light for satisfactory pro- 
pulsion into the larynx, and powdered talc should be added to it in 
small amount, with yg- grain (0.004) of morphine to each drachm (4.0) 
of iodoform. The odor is generally disagreeable to the patient, but if 
a cocaine spray be first applied to the fauces and the operator is skilful,, 
very little coughing is produced. As iodoform is a local anaesthetic, it 
relieves the pain in the larynx, acts as an antiseptic and alterative, and 
is peculiarly obnoxious to bacillus tuberculosis. 

Camphoric acid in 20- to 30-grain (1.3-2.0) doses is the best internal 
remedy for treating night-sweats. 

When the night-sweats are very profuse, hypodermic injections of 
atropine in the dose of yfit to TM grain (0.0004-0.0006) are useful in 
some cases, and the efficiency of this treatment may be increased by 
the use of an alum sponge-bath at bedtime. A solution of alum, 10 
to 20 grains to the ounce (0.60-1.3:30.0), may be sponged over the 
body, or sulphuric acid may be added to water in the proportion of 1 
drachm to the pint (4.0-480 c.c), and used in the same way as the 
alum solution. 

Sulphuric acid is often given internally with advantage in these cases 
of sweating. Small doses of pilocarpine amounting to -^V grain (0.003), 
given from one to two hours before the sweat is expected, are some- 
times potent for good. The means by which this result is brought 
about are not far to seek. The drug in any dose causes stimulation 
of the peripheral ends of the nerves supplying the sweat-glands. In 
many instances we find excessive secretion dependent upon depression 
of function, as in a serous diarrhoea or a local sweating of the feet. 
These states pass away just as soon as the parts regain their normal 
tone through proper treatment. The night-sweats of phthisis are 
sometimes improved by pilocarpine, because this drug in all doses 
stimulates the sweat-glands. In large doses this stimulation amounts 
to free diaphoresis; but in minute doses, such as -£$■ to -fa grain 
(0.0015-0.003), the stimulation just balances the depression and a 
normal tone is acquired. While it is true that pilocarpine and atropine 
are physiological antagonists, it will be found practically beneficial to 
prescribe small doses of both in such cases as refuse to respond to either 
one alone, as by their antagonism they prevent overaction on other 
parts of the body, and both act in harmony in so influencing the sweat- 
glands as to be of service to the patient. 

TYPHOID FEVER 

Any attempt to review the various forms of treatment of the disease 
known as typhoid fever is absolutely impossible, owing to the very 
numerous theories and practices put forward by various clinicians. 



TYPHOID FEVER. 809 

What is said under the general heading of Fever and under the con- 
sideration of Cold, Part III., and also under Antipyrin and Acetanilid, 
gives sufficient information as to the treatment of febrile movements, 
and the care of the patient beyond this point in nearly all cases depends 
upon the severity of the attack. 

Before going farther, however, the writer desires to insist very 
strongly upon one fact — namely, that a case of typhoid fever is not 
curable in any degree. No remedy yet found, except it act through 
the prevention of complications, can shorten the course of the disease. 
We can only guide the patient safely to health when the storm of dis- 
ease comes on, and we cannot stop the storm. 

Not only should the facts of the last paragraph be carefully borne 
in mind, but the physician must also remember that he is treating an 
exhausting disease — not a disease which runs a violent course for a 
few days and strands the patient sick and weak, but convalescent, 
upon the shores of health, but one in which, after sapping the strength 
for weeks, some sudden intercurrent malady or accident may ensue 
which will speedily kill him if every grain of strength is not preserved 
for the struggle. The physician should always put every case in which 
there is a suspicion of typhoid fever to bed at once, and keep the 
patient there till the disease has passed or fails to develop. Every 
muscular movement unnecessarily made is a waste of force, and, in 
consequence, everything should be done for the patient, and not by 
him. A bed-pan should always be employed, the patient not being 
allowed to sit erect upon a commode. 

Remembering, too, that a typhoid fever patient is subjected to pro- 
longed wasting fever and toxjemia for many days, his nutrition should 
be maintained by the use of a nourishing diet easy of digestion. In 
addition to milk he should also receive one or two very soft-boiled eggs 
each day, arrowroot and perhaps thin corn starch, provided they agree 
with his digestive powers. If diarrhoea is not present, broths may be 
given, but it must be recalled that Brieger has shown that typhoid 
bacilli do not readily reproduce themselves and their poisons in pep- 
tone and well-digested milk, but do so very actively in meat-broths or 
jelly which has not been acted upon by the digestive juices. Milk 
diet is therefore evidently better than a broth diet in typhoid fever, 
and we once more are able to explain an empirical fact by a scientific 
discovery. There is no reason for using liquid instead of solid foods, 
except the difficulty of digesting the latter. 

Alcohol has been used in all stages of typhoid fever as a stimulant, 
as a giver of force to the system, and as an aid to digestion, but its real 
value is found when actual depression exists. A very large part of 
the profession believe that the mere presence of an abnormally high 
temperature contraindicates the use of alcohol. Mere high tempera- 
ture does not do so, however. High temperature of a sthenic type, 
with a full, tense, bounding pulse and all the signs of a disease attack- 
ing one in the full vigor of life, of course precludes its use; but in the 



810 DISEASES. 

high temperature of advanced typhoid, with the marked asthenia 
often present in that stage, alcohol should be given whenever the 
heart-sounds are feeble. Under these circumstances the tissues 
which the man can afford to lose are gone, and much of his vitality is 
greatly encroached upon: the alcohol yields force to the body, and is 
burnt up in great part, keeping the flagging heart pumping the blood 
through the lungs and systemic circulation, when otherwise the circu- 
latory depression would result in hypostatic congestions, if not in more 
widespread circulatory disorder. 

A no less useful and valuable result obtained by the use of alcohol 
in the later stages of exhaustive fevers is the part that it plays in aiding 
digestion. The writer has elsewhere defined the difference between 
the influence of alcohol in the artificial digestion of the test-tube and 
that occurring in the stomach. Alcohol acts rather by restoring the 
equilibrium of the circulation than by a direct stimulant effect. It 
may also increase the bacteriolytic power of the blood. Aside from 
experimental evidence, every-day experience has taught the gourmand 
that alcohol, in *a fairly concentrated form, enables him to digest an 
amount of food which under ordinary circumstances would remain 
unchanged in his stomach. In those cases in which a temporary loss 
of heart-power is due to hemorrhage or to some sudden severe depres- 
sion, alcohol is one of the remedies to be employed — in a hot and 
concentrated form. 

The physician ought not to use alcohol as a routine measure in 
every case without a rational idea of why he does so, nor without a 
clear idea as to what indication is met by its use. In many cases it is 
not needed at any time. 

That alcohol may be misused and cause great harm is, of course, 
known to every practitioner of medicine. So long as it reduces the 
temperature and lowers the rate of the pulse, causes a moist skin and 
tongue, and quiets nervous twitchings, it does good, and only up to 
this point is it to be employed. If its administration is pushed after 
this, the tendency to adynamia becomes, under the overuse of the 
drug, one of dynamia; the pulse is no longer soft, but is felt as angry, 
bounding beats; the nervous symptoms change from low, weak, 
muttering delirium to talkative delirium and restlessness; and when 
the influence of the alcohol begins to decrease, and even before this 
time, the system has put forth the strength of days in a few hours, and 
the man, having no reserve strength, is in a dangerously feeble state. 

The treatment which is used by the author in his wards at the 
Jefferson Medical College Hospital has given him results which the 
application of other methods has failed to give, and is as follows : 

As soon as the patient enters the house he is washed or bathed and 
placed in bed, and required to remain there. He is assured that the 
more quietly he lies the more mild and safe will be the course of his 
attack, and is made to use a bed-pan and urinal, and never allowed to 
get up. He receives several small doses of calomel, followed, if the 



TYPHOID FEVER. 811 

bowels are not moved, by a mild saline purge, such as a Seidlitz powder. 
After the calomel has acted he is also given 5 drops (0.3) of dilute 
hydrochloric acid in a wineglass (30.0) of water every four hours, or, 
if the bowels are not active, nitromuriatic acid is substituted there- 
for, care being taken to employ 3 drops of the strong, freshly mixed 
acid according to the degree of coating of the tongue. The diet is 
largely a milk diet — namely, a quart to a quart and a half (1 to 1\ 
litres) a day, with a little salt to flavor it, as already described in the 
article on Indigestion. In some cases koumyss is an agreeable change 
from milk. Sometimes, if vomiting is threatened, lime-water is 
.added, or the milk is peptonized, or beef-tea is temporarily employed. 
In other instances the milk agrees with the patient if it is partly diluted 
with plain soda-water, Vichy or Apollinaris water. Eggs, arrowroot, 
-corn starch, and curds and whey are also allowed, as already indicated, 
and when starches are used it is the author's invariable rule to give 
taka-diastase in the dose of 2 grains with each meal. 

For the dry and sordes-covered tongue a mouth-wash of glycerin 
and water, half and half, to which may be added a little lemon-juice, 
is used, and it is important to keep the mouth constantly cleansed, as 
by this means swallowing is not interfered with through cracking of 
the lips, tongue, and buccal mucous membrane, pulmonary infection 
is avoided, and facial erysipelas and parotitis are prevented. 

If constipation is very obstinate and continues over one day, an 
injection is employed, and if this, after being used twice, fails to act, 
a dose of calomel, \ grain (0.001) every fifteen minutes till a grain 
has been taken, is prescribed, and, if no movement occurs in twelve 
hours, is followed by half a bottle of citrate of magnesium, or a tea- 
spoonful of liquorice powder is given. In other cases small doses of 
mascara sagrada are equally useful. Violent purgatives should never 
be used for obvious reasons. Rectal injections should be given some 
hours after the purgative is taken, to aid its action, since not infre- 
quently the laxative causes the contents of the small intestine to flow 
into the large bowel, which is too inactive to extrude them. 

When diarrhoea becomes troublesome — that is, more than three or 
four passages a day — the following will be of service : 

1$ — Acid, sulph. aromat foij (8.0). 

Fluidext. haematoxyli f 5iij (12.0). 

Syr. zingiberis f oiij (90.0). — M. 

S. — Teaspoonful (4.0) in water every hour until relieved. 

Should the stools be excessively fetid and tympanites be marked, 
guaiacol carbonate may be given as an intestinal antiseptic, or, so soon 
as any evidence of tympanites or much meteorism comes on, turpen- 
tine may be given, as follows: 

^—0\. terebinthinse . f 3ij (8.0). 

Syr. acacise q. s. ad f §iij (90.0). — M. 

Ft. in emulsio. 

S. — Teaspoonful (4.0) in milk three times a day. 



812 DISEASES. 

At the same time it is well to employ a turpentine stupe over the abdo- 
men. (See Turpentine.) Where the tympanites is excessive it may 
be relieved by an injection made as follows: 

1$ — 01. terebinthinse f5j to 3 ij (4.0-8.0). 

Ol. olivse fgiv (120.0). 

Emul. asafoetidae . . . . . . . Oj (480 c.c.).— M. 

S. — Use as an injection. Shake well before using. 

When the tympanites is severe, half an ounce (16.0) of Hoffmann's 
anodyne may be used in place of the turpentine. 

In the later stages of typhoid fever, as convalescence is approached, 
turpentine is often useful, as it seems to cause rapid healing of the 
intestinal ulcers and checks diarrhoea. 

Much has been said about the value of purgatives and so-called 
intestinal antiseptics in typhoid fever, and extravagant claims made 
for them. Suffice it to state that while they may be indicated in cer- 
tain cases they are not to be used as a routine plan of treatment, 
because the skill of the true physician is to give each patient what he 
needs — not to give all the same treatment. Typhoid fever cannot be 
aborted; it can only be modified in the sense that we place our patients 
in the best possible physical state to withstand its ravages. 

A point of importance in the treatment of typhoid fever is to see 
that the patient receives enough water in twenty-four hours. Owing 
to his apathy he often does not complain of thirst and the kidneys are 
not flushed of impurities by fluid. Some perfectly pure water, such as 
Londonderry Lithia, or Poland water, should be freely given to help 
eliminate toxic materials through the kidneys. Should toxaemia be 
severe, the use of cold is essential, and if in addition emaciation be 
marked, it is wise to employ hypodermoclysis. (See Part III.) 

Not infrequently cases are met with in which toxsemia with 
mental depression is well developed, yet in which the temperature is 
below 102° F., and so the use of cold sponging seems contraindi- 
cated. Active friction with tepid water and alcohol is now of value. 
If the temperature is normal or subnormal, the patient may be 
sponged with hot water. The value of this measure does not lie so 
much in the temperature of the water as in the reaction and conse- 
quent readjustment of the circulation. 

The complications of typhoid fever of the most serious import are 
hemorrhage from the bowel, pneumonia and pleurisy, and perforation 
of the bowel. 

The hemorrhage from the bowel may be treated as indicated under 
that heading (see Hemorrhage), and the pneumonia or pleurisy should 
be treated as are these diseases when they occur alone; but it is to be 
remembered that the patient is an asthenic adynamic case, and musr 
not be depressed, but stimulated. When perforation of the intestine 
occurs, sufficiently large doses of morphine should be given to relieve 
pain, prevent collapse, and allay irritation. Warm applications 



UREMIA. 813 

should be used over the belly and down the limbs, and stimulants 
given if needed. In all cases where it is possible to find a surgeon 
capable of doing a skilful abdominal section a consultation should be 
had at once. If shock is not present, operation should be performed 
immediately, the perforation or perforations found, closed, and the 
peritoneal cavity well flushed with warm normal saline solution, to 
cleanse it of extravasated intestinal contents. If shock is present, 
operation should be delayed until it is overcome and then be per- 
formed. 1 (See Shock.) 

As stated at the beginning of this article, cold bathing is very impor- 
tant and should always be employed in one of its forms if the fever is 
high, except in the presence of hemorrhage or perforation. 

For a number of days after the patient begs for solid food it 
should not be allowed, for he will ask for it long before he should 
have it; but if the temperature remains normal after nine days, the 
soft part of stewed oysters may be used and the patient gradually 
brought back to an ordinary simple diet. 

UREMIA. 

The treatment of this dangerous manifestation of renal disease is 
often futile, but always to be resorted to with the recollection that 
Avonderful recoveries sometimes occur under judicious management. 
It matters little whether the onset of the symptoms has been gradual 
or instantaneous: in either event the prime endeavor must be to rid 
the system of the poison which is threatening life. This can only be 
accomplished by aiding its elimination through the bowels, skin, 
and kidneys. The second indication is to support the vital organs 
until the emunctories have had time to act. Often this second indi- 
cation will be more pressing than the first, and the physician will 
have to give stimulants at once. The third indication is to arrest any 
convulsive seizures. 

The methods to be resorted to for the elimination of the ursemic 
poison are external and internal, externally the hot pack being resorted 
to to increase the activity of the skin. (See Heat, Part III.) Inter- 
nally we give elaterium or elaterin in the close of ^ grain (0.01) or^g- 
grain (0.004), respectively, for the induction of watery purging, which 
at once aids elimination through the bowel and relieves dropsy if pres- 
ent. The elaterin should be dissolved in a few drops of alcohol or 
in whiskey. The medication directed to increased action of the skin 
should consist of small doses, hypodermically — say J grain (0.008) — of 
hydrochloride of pilocarpine with strychnine 2V grain (0.003), but the 
pilocarpine is contraindicated unless the heart is strong and acting 
properly. Even if the heart seems strong its use is not devoid of dan- 
ger. It may be used in conjunction with the hot-pack or hot-air bath. 

bus 

1 For discussion of this condition see the author's work on the Medical Complications and 
Sequela^ of Typhoid Fever. Lea Brothers & Co., Philadelphia, 1899. 



814 DISEASES. 

If dropsy is present, the drug will have to be given by the mouth, as it 
will not be absorbed from the dropsical subcutaneous tissues. Pilo- 
carpine also tends to increase the activity of the kidneys, and in 
addition to this influence on the renal structure we may use caffeine in 
the dose of 2 grains (0.12) every four hours for three doses, to stimu- 
late the renal epithelium still remaining healthy to greater effort; or if 
the arterial tension is high we may give nitroglycerin to lower it and 
increase urinary flow. Should pulmonary oedema threaten, atropine 
may be used in full dose with advantage. 

For the support of the heart and respiratory function we employ 
strychnine hypodermically or by the mouth in the dose of ■%■$ to yq- 
grain (0.003-0.006), and follow it by the more powerful stimulant 
digitalis in the dose of 30 minims (2.0) of the tincture by the mouth. 
Hypodermic injections of ether are also very valuable if the tissues 
are not too cedematous for absorption to occur. 

The convulsions, if present or threatened, are to be combated by 
the use of an enema of 20 grains of chloral (1.3) and 60 grains (4.0) 
of bromide of sodium in 3 ounces (90.0) of starch-water, and the hot 
pack will also be of value, not only to produce sweating, but for its 
sedative influence on the nervous system. Should the convulsive 
tendencies be marked, chloroform inhalations may be employed until 
the chloral or bromide can be absorbed. 

Two other remedial measures should be resorted to in cases of 
ursemia for the relief of all the symptoms — namely, full venesection if 
the pulse is bounding, and hypodermoclysis. (See Part III.) Vene- 
section is contraindicated in the feeble, but as much as 1 to 2 pints 
(480-960) of blood may be withdrawn in a sthenic case from a vein in 
the arm. After the bloodletting or during its progress hypodermoclysis 
may be performed or a saline solution transfused into a vein. (See 
Transfusion.) Often deep insensibility is speedily removed by vene- 
section, which should be regarded as the sheet-anchor of treatment in 
those cases which have a high blood-pressure. The author also regards 
hypodermoclysis and intravenous transfusion of salt-solution as most 
useful methods of treatment in this state. 

VITREOUS DISEASES 

Vitreous opacities may be either dust-like, flaky, or dense and mem- 
branous. They impair vision in proportion to their number and 
density, and are to be detected with the ophthalmoscope. Patients 
detect them as floating dark spots in their field of vision, because the 
opacities cast a shadow upon the retina. If vitreous disease is syphil- 
itic, the usual remedies are indicated. Hypodermic injections of pilo- 
carpine act favorably, and in the earlier stages of the inflammations 
of the retina, choroid, iris, and ciliary body, upon which the opacities 
depend, leeches should be applied to the temple. Galvanism has been 
recommended. 



VOMITING. 815 



VOMITING. 



Vomiting is a symptom, not a disease, and arises from a large 
number of causes, some of which are very unimportant, others very 
serious. The most common cause is probably lack of proper diges- 
tion, with all that this implies; that is, gastro-intestinal irritation 
and perversion of normal function. Additional causes are cerebral 
hemorrhage, tubercular meningitis, cerebritis, uraemia, or diseases of 
the middle lobe of the cerebellum, all of which conditions cause irrita- 
tion of the vomiting centre. 1 

All these states may be considered as lesions of a centric character 
which directly or indirectly cause the vomiting centre to send out 
impulses. On the other hand, it is worthy of note that under certain 
circumstances vomiting may be reflex and dependent upon irritation 
of the nerves of the stomach or elsewhere which convey impulses to 
the muscles whose activity results in vomiting. These conditions are 
well represented by the vomiting which comes on in incarcerated 
hernia, or in pregnancy, or in that occurring during the passage of 
renal or hepatic calculi, or in indigestion. 

It is important to bear in mind that peripheral vomiting due to dis- 
order of the gastric walls may be dependent upon two conditions. 
The mucous membrane and its nerves may be overexcitable or they 
may be depressed. For this reason we shall find that two modes of 
treatment are necessary when this subject is considered below. 

The mechanism of vomiting consists in the closure of the pyloric 
sphincter, the contraction of the gastric muscles from the pylorus to 
the cardia, and at the same time, and more important than these 
movements, the contraction of the supplementary respiratory and 
abdominal muscles, which so compress the stomach as to drive its 
contents through the open oesophagus. The violence of the muscular 
contractions in the abdominal walls is greatest when the stomach is 
partly empty, and gives rise to the pain and exhaustion accompanying 
the condition known as retching. The practical point to be learned 
from this is that vomiting is always easier when the stomach is not 
empty; so if an emetic is given on an empty stomach-, as the popular 
expression runs, a large amount of liquid should precede or accom- 
pany it if possible. Dogs vomit easily because of the development of 
the gastric muscles, but they render the effort easier by filling the 
stomach with air, and so completely fill the viscus that its walls can 
contract on a resisting mass. 

Having described the mode and causes of vomiting, it remains to 
consider its treatment. 

It is needless to remark that the vomiting of cerebral disease is 
very intractable, and that very active agents must be used to check it. 
Probably the vomiting following etherization is centric, and should 

1 See Practical Diagnosis, by the author. Lea Brothers & Co., Philadelphia. 



316 DISEASES. 

be treated, as should all forms of obstinate emesis, by the injection 
into the rectum of 40 grains (2.60) of sodium or potassium bromide 
and 20 minims of deodorized laudanum in 4 to 8 ounces (120.0-240.0) 
of water. If this does not check the vomiting, a second injection may 
be given two hours after the first. A very valuable remedy in this state 
is acetanilid given in 1-grain (0.06) doses every half-hour in a drachm 
of brandy with cracked ice (see Acetanilid), and it is well to remember 
that inhalation of the fumes of vinegar from a cloth wetted with it will 
often be of service. 

When vomiting seems to be due to hyperexcitability of the gastric 
mucous membrane, so that very small amounts of food when swallowed 
are at once rejected, local anaesthetics and depressants are needed, the 
chief of these being chloretone, cocaine, and aconite. The last two 
drugs, however, have disadvantages, because in effective dose their 
general physiological action may be very severe and almost poison the 
patient. When given as antiemetics, these drugs act as local anaes- 
thetics, or, in other words, by paralyzing the peripheral sensory nerves 
of the stomach. Cocaine should be given in the dose of 2 to 3 minims 
(0.1-0.20) of a 4 per cent, watery solution every fifteen minutes until 
10 minims (0.60) are taken. And it is best given in capsule so as to 
exert all its effects on the stomach rather than on the mouth and 
oesophagus. The aconite should be used in the form of the tincture, 
the patient being placed flat on the back, so as to withstand the ensuing 
cardiac depression with the least inconvenience, and 6 to 10 minims 
(0.40-0.60) of the tincture given in a little water every thirty minutes 
until the rapidly weakening pulse forbids its further use. This drug 
may be resorted to in all forms of vomiting due to irritability of the 
stomach, but it is contraindicated in cases of debility or weakness. 

Two grains of chloretone given in capsule or dissolved in a little 
brandy, and repeated every hour for 5 doses, are very efficient. 

Sometimes a prescription of the following character is of service, 
the bismuth acting as a coating to the walls of the stomach, protecting 
and soothing them : 

1$ — Bismuthi subnitrat. .... ^iij (12.0). 

Fhndext. aconiti ..... niiij vel vj (0.20-0.40).— M. 
Ft. chart, No. x. 
S. — One powder every half-hour. 

In other cases of the same type the following is useful, and is to be 
preferred if, owing to active fermentation, the vomiting is excessive 
(the creosote or phenol being a local anaesthetic and antiseptic) : 

J\ — Phenolis vel creosoti (beechwood) . gtt. x vel xx (0.60-1.3). 

Bismuthi subnitratis ..... ^iij (12.0). — M. 
Ft. in chart. No. x. 
S. — One powder every hour. 

In other cases 1 drop of tincture of iodine and 1 drop of phenol in a 
couple of drachms of water will act very well. 



VOMITING. 817 

Sometimes pure chloroform in 1- or 2-drop (0.05-0.1) doses, in a 
little water, does good; and dilute hydrocyanic acid, in the dose of 2 
to 5 minims (0.1-0.3) is also of value in like instances, given in a 
tablespoonful (16.0) of water. 

In other instances small repeated doses of nitroglycerin do good. 
Particularly is nitroglycerin useful in the nausea which often follows 
the use of opium, although this symptom is best prevented by its pre- 
liminary use. The dose used should be about -g-J-g- grain (0.0002) every 
half-hour. 

The treatment of a case of vomiting dependent rather upon depres- 
sion and debility of the stomach than upon irritation is directed to the 
administration of gastric and, it may be, systemic stimulants. The 
chief of the gastric stimulants is ipecac in small doses, and it is this 
employment of a drug generally resorted to for the production of 
emesis by physicians which has caused homoeopaths to claim that the 
regular school obey the rule of similia similibus curantur and infinitesi- 
mal doses. The claim only holds good on its face, for we do not use 
an infinitesimal dose, and obey no law, but use common sense. Ipecac 
is an irritant, even to the skin, and it is partly by its irritant effects 
that it causes vomiting by exciting the stomach to a point over and 
above its normal condition. In the vomiting depending upon gastric 
debility and depression small doses of ipecac do good because they 
irritate the stomach sufficiently to restore its normal tone without 
going to the other extreme of hyperexcitation. Under these circum- 
stances a drop dose of the wine of ipecac, or \ grain (0.015) of the 
powdered ipecac, every hour, is of the greatest value, often succeeding 
after all other remedies have failed. 

In other instances tincture of nux vomica, given in J- to 1 -minim 
(0.025-0.05) doses, is useful as follows: 

1^ — Tinct. nu cis vomicae .... gtt. iv vel viij (0.25-0.5). 

Aquae cinnamomi i%] (30.0). — M. 

S. — Teaspoonful (4.0) every half-hour or later. 

In the nausea and vomiting following an alcoholic debauch \ to 1 
minim (0.025-0.05) of Fowler's solution every two hours, or before 
food, often gives relief, and it may be used in some cases in place of 
the nux vomica and ipecac. Another useful measure for the cure of 
alcoholic nausea is the use of full doses of hydrochloric acid, 5, 10, or 
15 minims (0.3-0.60-1.0) of the dilute acid in half a tumblerful of 
water, repeated every two hours. 

In all cases of persistent vomiting counterirritation should be applied 
over the stomach in the form of a mustard plaster, or, if preferred, an 
ice-bag may be applied to the nape of the neck, the lumbar spine, or 
the epigastrium. Sometimes the application of the positive electrode 
of the rapidly interrupted induced or faradic current between the 
sternoclavicular muscles while the negative electrode is placed on 
the epigastrium will give relief. In still other cases the skin over the 

52 



818 DISEASES. 

vagus nerves in the neck may be frozen by the use of a chloride of 
ethyl spray, or blisters may be applied in its stead. 

The food given in cases of vomiting should be especially prepared. 
It is always best to use peptonized milk, made by using the pepton- 
izing materials sold by all reliable drug firms (See Diet, Part III.) 
Lime-water should always be put in the milk if it is not peptonized; 
the small amount usually employed is perfectly useless at least 2 to 
3 tablespoonfuls (30.0-45.0) should be placed in each glass of milk. 

Another point of importance is the quantity of liquid taken. As 
fast as the patient vomits he is often fed with glasses full of liquid by 
well-meaning friends. Instead of this, he should have only 1 or 2 
teaspoonfuls (4.0-8.0) of milk every hour, half-hour, or fifteen min- 
utes, for it is better for him to retain a drachm than to take a quart 
and vomit it. Often milk will disagree with the patient, and then he 
may be given with excellent result barley gruel, which has been 
strained, and follow it by 3 grains (0.20) of taka-diastase. In its place 
strained gruel made from wheaten grits, oatmeal, or rice may also be 
used. 

Where vomiting is persistent enemata previously partly or entirely 
digested must be resorted to to sustain strength. 



WHOOPING-COUGH. 

The remedies recommended for this disease are almost as numerous 
as the members of the medical profession, and every one of them is 
worthless so far as a cure is concerned. Probably the very best drug 
of all in the majority of cases is antipyrin. Given in the dose of J to 3 
grains (0.03-0.20) every five hours according to the age of the child 
it will nearly always decrease the number of paroxysms, but not the 
severity of each individual attack. 

Where the child will submit to it there is little doubt that a solution 
of quinine applied to the pharynx by means of a very fine spray will be 
of service in many cases, and it is very useful when so used, as a 
prophylactic in other children of the family who it is feared will be 
attacked by the same disease. The strength of the solution to be 
employed should be about 1 grain (0.06) to the ounce of water. 

There is no doubt that carburetted hydrogen as inhaled in the air at 
gas-works is useful as a curative measure in some cases of whooping- 
cough. 

A very useful remedy in some cases is belladonna in the form of the 
tincture, in the dose of 2 minims (0.10) twice a day to a child of one or 
two years. 

Where paroxysms come on so rapidly as to interfere seriously with 
respiration, the child should inhale a whiff of chloroform poured over 
the parent's hand, and so relax the spasm, while in other instances 
nitrite of amyl is equally serviceable. Only 2 or 3 minims of the 



WOBMS. 81^ 

nitrite of amyl should be used at a time, and this fact must be impressed 
upon the parents. 

Benzine has been found useful in certain cases of whooping-cough. 
It should be lightly sprinkled about the room or on the bed-clothing, 
care being taken that no fire or light is present. In France it has been 
used internally in the dose of 10 to 15 minims (0.6-1.0) for this affection. 
This is scarcely to be recommended. 

Bromoform renders good service in some cases. (See article on 
Bromoform for prescription.) 

The vomiting following the cough may be overcome by using such 
minute amounts of milk as to enable nutrition to go on without at any 
time overloading the stomach, as, for example, a teaspoonful (4.0) 
after each paroxysm of cough. 

Usually it will be found advisable to modify the severity and fre- 
quency of the attacks by keeping the patient under a bronchitis-tent or 
by keeping the air of the room moistened by steam. (See Bronchitis.) 

WORMS. 

Intestinal parasites may be said to be represented by Ascaris 
lumbricoides or round-worm; Taenia solium, Taenia saginata, and 
Bothriocephalus latus, or tape-worms; and, finally, by Oxyuris ver- 
micularis sometimes called seat-, pin-, or thread-worm. A very much 
rarer form of intestinal parasite, but one which is quite frequently 
found in some parts of the world, is Anchylostoma duodenale. 

The round-worm, tape-worm, and anchylostoma are to be attacked 
by way of the patient's mouth, the seat-worm by way of the anal open- 
ing; but before mentioning the drugs to be employed it is necessary 
to insist upon one or two important points, disregard of which will result 
in failure in treatment. 

Whenever a round- or tape-worm is to be attacked, the patient 
must be starved for at least twelve to twenty-four hours, in order that 
no food in the intestinal tract may protect the worm from the action 
of the drug. During this time a little milk may be taken, and after 
a night of fasting, before breakfast, the anthelmintic must be swal- 
lowed. In addition, nearly all of these drugs must be followed by- 
purges in order to dislodge the intruder while he is paralyzed and 
has lost his hold; and in many instances it is well to have a basin of 
salt and water ready, so that when a passage occurs a rectal injection 
may be given to wash out any segments of the worm which remain 
in the rectum. 

In the treatment of thread-worms it is necessary to fill the bowel 
thoroughly with soap and water to dislodge the fecal matter and 
expose the worms in the folds of the mucous membrane. 

The drugs which are used against the round-worm are: spigelia in 
the form of the fluid extract, dose 1 drachm (4.0) to a child of two 
or three years, or 2 drachms (8.0) to an adult, or, better still, the fluid 



820 DISEASES. 

extract of spigelia and senna, dose 2 to 3 drachms (8.0-12.0) given 
in divided doses, to a child; santonin, dose J to \ grain (0.015-0.03) 
to a child in the form of troche, made by using the crystals, or as much 
as 2 to 4 grains (0.12-0.25) to an adult. (See Santonin.) 

Unless the spigelia is used with senna, it should always be followed 
after from two to four hours by a full dose of castor oil or a saline 
purgative to sweep out the worm, and the same rule applies to all the 
drugs mentioned above. 

Brayera, or kooso, is given for the removal of the tape-worm in the 
form of an infusion, which is made by adding \ ounce (16.0) of the 
powdered leaves to 1 pint (480 c.c.) of water and mucilage of acacia, 
one-half of each. This may be taken at one dose, or the fluid extract 
may be given in the dose of J ounce (16.0) to an adult. Koosin may 
be given in 40-grain (2.60) doses in capsule to adults, but it should 
not be used against worms in pregnant women, as it may cause 
abortion. 

The most efficient remedy against the tape-worm is pelletierine, the 
active principle of pomegranate, dose 3 to 5 grains (0.20-0,30) in 
capsule; or pepo, or pumpkin-seeds (2 ounces [60.0]), may be resorted 
to when deprived of their outer coating and rubbed into a paste with 
sugar. Almost, if not quite, as valuable a remedy is male fern, or 
Filix mas, or, as it is officially called, Aspidium. Used in the form 
of the oleoresin (Oleoresina Aspidii), in the dose of \ to 1 drachm 
(2.0-4.0) to an adult, it should be followed in three or four hours by a 
calomel purge, aided by a saline. Either the calomel or the increased 
amount of bile which is present is apparently peculiarly abhorrent to 
the tape- worm, and its free flow should be made to follow the use of 
all the drugs just named. Aspidium should not be followed by castor 
or other oils, as they increase the absorbability of the drug, and so 
tend to develop symptoms of poisoning. 

For the removal of Anchylostoma duodenale thymol in the dose 
of 2 to 4 grains (0.12-0.25) or more may be given in capsule once a 
day and followed by a purge. 

By far the most useful remedy for seat-worms is quassia used by 
injection. One to 2 ounces (30.0-60.0) of powdered quassia or quassia 
chips may be made into a decoction with a pint (480 c.c.) of water, 
and half of this injected into the rectum after it has been well cleansed 
with soap and water. The quassia injection should be retained in 
the bowel for some minutes, and in children this may be accomplished 
by pressing upon the anal opening the ball of the thumb covered by a 
pad formed from a small folded towel. If this treatment fails to 
bring away all the worms in three or four trials, either there are none 
present or the bowel was not thoroughly invaded by the injection. In 
some cases the worms infest the colon, and large injections sent high 
up into the bowel are necessary. 



DOSES OF MEDICINES. 



The doses in this table are commonly employed. They are not always equivalent 
to those given in the text, which are used by the author as a rule. 

dr.= drachm; ft. dr. = fluidrachm ; /. oz. =fluidonnce; gr.= grain; fpn. = gramme ; 
cc. cubic centimetre ; min. = minim ; oz. = ounce. *• 



Acetanilid 

Acetophenone 

Acetphenetidin 

Acetum lobelia) 

opii . . 

sanguinarise 

scillie . 

Acid, acetic, diluted . . . 

arsenous 

solution of (Ph. U. S. 

benzoic 

boric 

carbolic 

chrysophanic 

citric 

fluoric, dilute 

gallic 

hydriodic, dilute . . . 

hydrobromic, dilute . . 

hydrochloric 

dilute 

hydrocyanic, dilute . . 

lactic 

nitric 

dilute 

nitrohydrochloric . . . 

phosphoric, dilute . . . 

picric 

polygalic 

salicylic . 

sulphuric 

aromatic 

dilute 

sulphurous ...... 

tannic 

tartaric 

valerianic 

Aconite, abstract of . . . 

leaves, extract of . . . 
fluid extract of . . . 
tincture of 

root, extract of . . . . 
fluid extract of . . . 

tincture of 

Aconitine * 

Adonidin 

^Ether. See Ether. 



Dose. 



Apothecaries' 
Weights and Measures. 



1-8 gr. 

5-20 min. 

2-5 gr. 
15-30 min. 

5-10 min. 
15-30 min. 
10-30 min. 

1-2 fl. dr. 

eWff g r - 

2-8 min. 

5-15 gr. 

5-10 gr. 

i-1 g r - 

i-5gr. 

5-20 gr. 
10-20 min. 

3-15 gr. 

l fl. dr. 

f-2fl.dr. 

2-5 min. 
10-20 min. 

2-5 min. 

1-3 dr. 

2-5 min. 
10-25 min. 

2-5 rain. 

5-25 min. 

1-5 gr. 

i-lgr. 

5-15 gr. 

2-5 min. 

5-20 min. 

5-20 min. 

i-1 fl. dr. 

2-10 gr. 
10-30 gr. 

3-4 min. 

i-igr- 

i-^gr- 
1-5 min. 
10-30 min. 

i-i gr : 
|— 1 min. 
5-10 min. 
■thsvs g r - 
tW gr- 



Metric 
System. 



0.06-0.5 gm. 

0.3-1.3 cc. 
0.12-0.3 gm. 

1.0-2.0 cc. 

0.3-0.6 cc. 

1.0-2.0 cc. 

0.6-2.0 cc. 

4.0-8.0 cc. 
0.001-0.003 gm. 
0.10-0.5 cc. 

0.3-1.0 gm. 

0.3-0.6 gm. 
0.03-0.06 gm. 
0.008-0.3 gm. 

0.3-1.30 gm. 

0.6-1.30 cc. 

0.2-1.0 gm. 
2.0 cc. 

2.0-8.0 cc. 
0.10-0.3 cc. 

0.6-1.3 cc. 
0.10-0.3 cc. 

4.0-12.0 gm. 
0.10-0.3 cc. 

0.6-1.5 cc. 
0.10-0.3 cc. 

0.3-1.5 cc. 

0.06-0.3 gm. 

0.015-0.06 gm. 

0.3-1.0 gm. 
0.10-0.3 cc. 

0.3-L3 cc. 

0.3-1.3 cc. 

2.0-4.0 cc. 
0.12-0.6 gm. 

0.6-2.0 gm. 

0.2-0.25" cc. 
0.015-0.03 gm. 
0.015-0.03 gm. 
0.06-0.3 cc. 

0.6-2.0 cc. 

0.01-0.015 gm. 

0.025-0.05 cc. 

0.30-0.60 cc. 

0.00015-0.0002 gm. 

0.005-0.01 gm. 

(821) 



822 



DOSES OF MEDICINES. 



Remedy. 



Agaricin 

Aloes 

extract of 

and myrrh, tincture of 

tincture of 

watery extract 

wine of 

Aloin 

Alumen 

(as emetic) 

Aluminium hydrate 

Ammonia, aromatic spirit 

solution of acetate of . 

spirit of 

water of 

Ammoniacum 

mixture 

Ammonium benzoate 

bromide 

carbonate 

chloride 

iodide ... 

phosphate 

picrate 

salicylate 

sulphate 

valerate 

Amygdala amara, water of 

Amyl nitrite 

by inhalation 

Amylene hydrate 

Amylum iodatum 

Angelica- root, fluid extract 

Angustura-bark 

Anise, oil of 

spirit of . . 

Anthemis 

extract 

fluid extract 

Antimonial powder 

Antimony oxide 

oxysulphuret - 

and potassium tartrate, as diaphoretic 
as emetic 

sulphide 

sulphurated 

sulphuret 

wine of 

frTrtipyrine 

A ntitoxine (for diphtheria) 

Apiol 

Apocynin ... 

Apocynum cannabinum 

fluid extract of 

Apomorphine hydrochloride 

Aralia hispida, fluid extract of ... . 

nudicaulis, fluid extract of 

racemosa, fluid extract of 

spinosa, fluid extract of 

Arbutin 

Areca, fluid extract of . . • .... 
Argentum and compounds. See Silver. 
Arnica-flowers, extract of 



Dose. 



Apotheoaries' 
Weights and Measures. 



T2-? gr- 
2-6 gr. 
2-6 gr. • 
1-2 fl. dr. 
1-2 fl. dr. 
i-2 gr. 
1-2 fl. dr. 

Hgr- 

5-10 gr. 
30 gr.-l dr. 

5-15 gr. 
30 min.-l fl. dr. 

1-2 fl. dr. 

5-15 min. 

5-15 min. 
10-30 gr. 

J-l oz. 
10-20 gr. 
10-30 gr. 

3-10 gr. 

5-10 gr. 

3-5 gr. 
10-20 gr. 

i-igr. 

5-20 gr. 

3-10 gr. 

2-8 gr. 

1-2 fl. dr. 

2-3 min. 

3-5 min. 
10-30 min. 

5-30 gr. 
30-60 min. 
10-30 gr. 

1-5 min. 

1-2 fl. dr. 

i-l dr. 

2-10 gr. 
30-60 min. 

1-3 gr. 

2-3 gr. 

1-2 gr. 
TV? gr- 

*-l gr. 

1-2 gr. 

1-2 gr. 

1-2 gr. 
10 min.-l fl. dr. 

5-15 gr. 
2000-5000 units. 

2-5 min. 

|-2 gr. 
10-20 gr. 
10-30 min. 

tWo g r - 
30-60 min. 
30-10 min. 
30-60 min. 
30 -60 min. 

1-10 gr. 
30-60 min. 



Metric 
System. 



0.005-0.015 gm. 
0.12-0.40 gm. 
0.12-0.40 gm. 

4.0-8.0 cc. 

4.0-8.0 cc. 
0.03-0.12 gm. 

4.0-8.0 cc. 
0.015-0.03 gm. 

0.3-0.6 gm. 

2.0-4 gm. 

0.3-1.0 gm. 

2.0-4.0 cc. 

4.0-8.0 cc. 

0.3-1.0 cc. 

0.3-1.0 cc. 

0.6-2.0 gm. 
16.0-30.0 cc. 

0.6-1.3 gm. 

0.6-2.0 gm. 
0.20-0.6 gm. 

0.3-0.6 gm. 
0.20-0.3 gm. 

0.6-1.3 gm. 
0.015-0.03 gm. 

0.3-1.3 gm. 
0.20-0.6 gm. 
0.12-0.50 gm. 

4.0-8.0 gm. 
0.10-0.20 cc. 
0.20-0.3 cc. 

0.6-2.0 gm. 

0.3-2.0 gm. 

2.0-4.0 gm. 

0.6-2.0 gm. 

0.05-0.3 cc. 

4.0-8.0 cc. 

2.0-4.0 cc. 
0.12-0.6 gm. 

2.0-4.0 cc. 
0.06-0.20 gm. 
0.12-0.20 gm. 
0.03-0.12 gm. 
0.004-0.03 gm. 
0.03-0.06 gm. 
0.03-0.12 gm. 
0.06-0.12 gm. 
0.03-0.12 gm. 

0.6-4.0 cc. 

0.3-1.0 gm. 



0.10-0 

0.03-0 

0.6-1 

0.6-2 

0.004-0 

2.0-4 

2.0-4 

2,0-4 

2.0-4 

0.06-0 

2.0-4 



.30 cc. 
.12 gm. 

.3 gm. 
Oca 
.006 gm, 
.Occ. 
.Occ. 
.Occ. 
.0 cc. 
.6 gm. 
.Occ. 



2-5 



gr. 



0.12-0.3 gm. 



DOSES OF MEDICINES. 



823 



Remedy. 



Arnica-flowers, fluid extract of 

root, extract of 

fluid extract of - . . 

tincture of 

Aromatic powder 

Arsenate of sodium, solution of 

Arsenic. See Acid, arsenous. 

bromide 

iodide 

and mercury iodide, solution of (Dono- 
van's solution) . 

Arsenite of potassium, solution of (Fowler's 

solution) 

Asafoetida 

mixture of 

tincture 

Asclepias incarnata, fluid extract of . . . 

Syriaca, fluid extract of 

tuberosa 

Aspidium. fluid extract of 

oleo-resin of 

Aspidosperma, abstract of 

fluid extract of 

Atropine sulphate 

Aurantii cortex, fluid extract of 

Azedarach, fluid extract of 

Balsam of Gurjun 

of Tolu 

Eaptisia, extract of 

fluid extract of 

Baptisine 

Belladonna, abstract of 

alcoholic extract of 

leaves, fluid extract of 

tincture of 

root, extract of 

fluid extract of 

Benzanilide 

Benzoin, compound tincture of 

tincture of 

Benzol 

Berberina 

sulphate 

Berberis aquifolium, fluid extract of . . . 

vulgaris, fluid extract of 

Beta-naphthol . 

Bismuth and ammonium, citrate of . . . . 

citrate 

salicylate . 

subcarbonate . 

subgallate . . 

subnitrate 

subsalicylate 

tannate 

valerate ' 

Boldo, fluid extract of 

oil of 

tincture of 

Brayera 

fluid extract of 

infusion of 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


5-15 min. 


0.3-1.0 cc. 


2-5 gr. 


0.12-0.3 gm. 


5-15 min. 


0.3-1.0 cc. 


10-20 min. 


0.6-1.3 cc. 


10-30 gr. 


0.6-2.0 gm. 


3-5 min. 


0.20-0.3 cc. 


sWV g r - 


0.001-0.003 gm. 


tW g r - 


0.004-0.008 gm. 


2-4 min. 


0.1-0.25 cc. 


2-5 min. 


0.1-0.3 cc. 


5-20 gr. 


0.3-1.3 gm. 


\-l fl. oz. 


16.0-30.0 cc. 


30 min.-l fl. dr. 


2.0-4.0 cc. 


15-30 min. 


1.0-2.0 cc. 


15-30 min. 


1.0-2.0 cc. 


15-30 min. 


1.0-2.0 gm. 


1-2 fl. dr. 


4.0-8.0 cc. 


30 min.-l fl. dr. 


2.0-4.0 cc. 


5-20 gr. 


0.3-1.3 gm. 


15-30 min. 


1.0-2.0 cc. 


tIWo g r - 


0.0005-0.0015 gm. 


15 min.-2 fl. dr. 


1.0-8.0 cc. 


15-60 min. 


1.0-4.0 cc. 


20-30 min. 


1.3-2.0 cc. 


10-30 min. 


0.6-2.0 cc. 


2-10 gr. 


0.12-0.6 gm. 


10-30 min. 


0.6-2.0 cc. 


2-5 gr. 


0.12-0.3 gm. 


i-H gr- 


0.03-0.1 gm. 


i-?g r - 


0.015-0.03 gm. 


3-6 min. 


0.20-0.40 cc. 


5-30 min. 


0.3-2.0 cc. 


Hgr. 
1-2 min. 


0.008-0.015 gm. 


0.05-0.10 cc 


1-5 gr. 


0.06-0.3 gm. 


i-1 fl. dr. 


2.0-4.0 cc. 


\-\ fl. dr. 


2.0-4.0 cc. 


5-1 min. 


0.3-0.6 cc. 


3-10 gr. 


0.20-0.6 gm. 


3-10 gr. 


0.20-0.6 gm. 


15-30 min. 


1.0-2.0 cc. 


15-30 min. 


1.0-2.0 cc. 


£-5 gr. 


0.03-0.3 gm. 


1-10 gr. 


0.06-0.6 gm. 


3-15 gr. 


0.20-1.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


5-20 gr. 


0.3-1.2 gm. 


3-10 gr. 


0.2-0.6 gm. 


5-20 gr. 


0.3-1.2 gm. 


5-10 gr. 


0.3-0.6 gm. 


5-30 gr. 


0.3-2.0 gm. 


1-3 gr. 


0.06-0.18 gm. 


5-15 min. 


0.3-1.0 cc. 


5 min. 


0.3 cc. 


8 min. 


0.5 cc. 


2-4 dr. 


8.0-16.0 gm. 


2-4 fl. dr. 


8.0-16.0 gm. 


4-8 oz. 


120.0-240.0 cc. 



824 



DOSES OF MEDICINES. 



Remedy. 



Bromal 

Bromoform 

Brucina 

Bryonia, fluid extract of 

tincture of 

Buchu, fluid extract of 

Buckthorn, fluid extract of 

Cactus grandiflora, fluid extract of . . 
Caffeine 

citrated 

Cajuput, oil of 

Calamus, fluid extract of 

Calcium benzoate - . 

bromide 

carbonate 

chloride 

hypophosphite 

iodide 

lactophosphate, syrup of 

phosphate 

sulphide 

Calendula, fluid extract of 

tincture of 

Calomel. See Mercury, mild chloride of. 
Calumba, extract of 

fluid extract of 

tincture of .-...'. 

Calx chlorinata 

sulphurata 

Camphor 

bromide 

monobromated . 

spirit of. 

water 

Camphoric acid 

Cannabin tannate 

Cannabis Americana, fluid extract of . 

Indica, abstract of 

extract of 

fluid extract of 

tincture of 

Cantharides 

tincture of 

Capsicum 

fluid extract of 

oleoresin of 

tincture of 

Caraway, oil of . 

Carbon bisulphide . . . 

Cardamom, compound tincture of . . 

fluid extract of 

tincture of 

Caryophyllus, oil of 

Cascara sagrada 

extract of 

fluid extract of 

Cascarilla 

fluid extract of 

Cassia fistula, pulp of 

Castanea vesca, fluid extract of . . . . 
Castor 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


2-3 gr. 


0.12-0.2 gm. 


5-10 min. 


0.3-0.6 cc. 


1 _ 1 (TV 

3 2 16 s 1 - 


0.002-0.004 gm. 


15-60 min. 


1.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


i-1 fl. dr. 


2.0-4.0 cc. 


15-30 min. 


1.0-2.0 cc. 


5-10 min. 


0.3-0.6 cc. 


2-5 gr. 


0.12-0.3 gm. 


2-5 gr. 


0.12-0.3 gm. 


5-20 min. 


0.3-1.3 cc. 


15-60 min. 


1.0-4.0 cc. 


10 gr. 


0.6 gm. 


10-20 gr. 


0.6-1.3 gm. 


15-30 gr. 


1.0-2.0 gm. 


5-10 gr. 


0.3-0.6 gm. 


10-30 gr. 


0.6-2.0 gm. 


1-3 gr. 


0.06-0.20 gm. 


1-2 fl. dr. 


4.0-8.0 cc. 


15-30 gr. 


1.0-2.0 gm. 


Hr g r - 


0.012-0.03 gm. 


10-30 min. 


0.60-2.0 cc. 


20-60 min. 


1.3-4.0 cc. 


3-10 gr. 


0.20-0.6 gm. 


15-60 min. 


1.0-4.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


2-5 gr. 


0.12-0.3 gm. 


1-1 gr. 


0.015-0.06 gm. 


2-10 gr. 


0.12-0.6 gm. 


2-5 gr. 


0.12-0.3 gm. 


2-5 gr. 


0.12-0.3 gm. 


5-30 min. 


0.3-2.0 cc. 


f-2 fl. oz. 


16.0-60.0 cc. 


15-30 gr. 


1.0-2.0 gm. 


5-10 gr. 


0.3-0.6 gm. 


3-15 min. 


0.20-1.0 cc. 


1-3 gr. 


0.06-0.20 gm. 


H g r - 


0.015-0.06 gm. 


3-6 min. 


0.20-0.40 cc. 


10-30 min. 


0.6-2.0 cc, 


1-1 gr- 


0.03-0.06 gm. 


2-10 min. 


0.10-0.6 cc. 


i-2 gr. 


0.03-0.12 gm. 


i-2 min. 


0.025-0.10 cc 


^-1 min. 


0.015-0.05 cc. 


3-10 min. 


0.20-0.60 cc. 


1-5 min. 


0.05-0.3 cc. 


l-l min. 


0.025-0.05 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


15-45 min. 


1.0-3.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


1-5 min. 


0.05-0.3 cc. 


10-30 gr. 


0.60-2.0 gm. 


2-8 gr. 


0.12-0.5 gm. 


10-30 min. 


0.6-2.0 cc. 


20-30 gr. 


1.3-2.0 gm. 


20-30 min. 


1.3-2.0 cc. 


1-2 dr. 


4.0-8.0 gm. 


1-1 fl. dr. 


2.0-4.0 cc. 


1 10-30 gr. 


0.6-2.0 gm. 



DOSES OF MEDICINES. 



825 



Remedy. 



Castor, tincture of 

Cataria, fluid extract of 

Catechu 

compound tincture of 

fluid extract of 

Caulophyllin 

Caulophyllum, infusion of 

Cava-cava . . . . . 

Cerium nitrate . 

oxalate 

Chalk, compound powder of 

mixture 

prepared 

Chamomile, oil of 

Charcoal, animal, purified 

Chelidonium majus 

extract of 

fluid extract of 

Chenopodium, oil of 

Cherry- laurel water 

Chimaphila, fluid extract of 

Chinoidin 

Chionanthus, fluid extract of ... . 
Chiretta, fluid extract of 

tincture of 

Chloral, hydrated 

Chloralformamide 

Chlorine-water 

Chloroform, mixture of 

purified 

spirit of 

Chrysarobin 

Cimicifuga, fluid extract of 

tincture of 

Cinchona-bark 

aromatic fluid extract of 

compound tincture of 

extract of 

fluid extract of 

tincture of 

Cinchonia sulphate 

Cinchonidia or Cinchonidine sulphate 

Cinchonine sulphate 

Cinnamon 

oil of 

spirit of 

tincture of 

Cloves. See Caryophyllus. 

Coca, fluid extract of 

leaves of . 

Cocaine 

Cocculus, fluid extract of 

tincture of 

Codeine or Codeia 

Colchicine 

Colchicum, acetic extract of 

corm 

extract of 

fluid extract of 

wine of 

seed 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


2-4 fl. dr. 


8.0-16.0 cc. 


15 min.-l fl. dr. 


1.0-4.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


£-2 fl. dr. 


2.0-8.0 cc. 


10-30 min. 


0.6-2.0 cc. 


Wg*. 


0.015-0.03 gm. 


1-2 oz. 


16.0-60.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


1-2 gr. 


0.06-0.12 gm. 


2-5 gr. 


0.12-0.3 gm. 


10-30 gr. 


0.6-2.0 gm. 


1-2 fl. oz. 


30.0-60.0 cc. 


15-30 gr. 


1.0-2 gm. 


5-15 min. 


0.3-1.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


l-l dr. 


2.0-4.0 gm. 


5-10 gr. 


0.3-0.6 gm. 


30-60 min. 


2.0-4.0 cc. 


4-8 min. 


0.25-0.5 cc. 


5-30 min. 


0.3-2.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


30-60 min. 


2.0-4.0 cc. 


10-30 fl. dr. 


0.6-2.0 cc. 


15-60 min. 


1.0-4.0 cc. 


5-20 gr. 


0.3-1.3 gm. 


15-30 gr. 


1.0-2.0 gm. 


1-4 fl. dr. 


4.0-10.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


5-10 min. 


0.3-0.6 cc. 


10 min.-l fl. dr. 


0.6-4.0 cc. 


5-20 gr. 


0.3-1.3 gm. 


10-30 min. 


0.6-2.0 cc. 


|-1 fl. dr. 


2.0-4.0 cc. 


10 gr.-l dr. 


0.6-4.0 gm. 


30-60 min. 


2.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


5-15 gr. 


0.3-1.0 gm. 


10-30 min. 


0.6-2.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


10-20 gr. 


0.6-1.3 gm. 


10-30 gr. 


0.6-2.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


5-20 gr. 


0.3-1.3 gm. 


1-5 min. 


0.05-0.3 cc. 


5-20 min. 


0.3-1.3 cc. 


i-2 fl. dr. 


2.0-8.0 cc. 


20 min.-l fl. dr. 


1.3-4.0 cc. 


l-l dr. 


2.0-4.0 gm. 


i-1 g^ 


0.03-0.06 gm. 


1-3 min. 


0.05-0.2 cc. 


2-10 min. 


0.10-0.6 cc. 


1-2 gr. 


0.06-0.12 gm. 




0.0006-0.0012 gm. 


\~\ g r - 


0.015-0.03 g:n. 


2-5 gr. 


0.12-0.3 gm. 


1 1 orr 


0.015-0.0:; gm. 


2-5 min. 


0.10-0.3 cc. 


10-20 min. 


0.6-1.3 cc. 


2-10 gr. 


0.12-0.6 gm. 



826 



DOSES OF MEDICINES. 



Remedy. 



Colchicum, seed, fluid extract of . 

tincture of 

wine of 

Colocynth 

compound extract of 

extract of 

Colocynthidine 

Colocynthin 

Condurango, fluid extract of . . . 
Coniine 

hydrochloride 

Conium, abstract of 

fluid extract of 

fruit, alcoholic extract of . . . 

fluid extract of 

tincture of 

leaves, extract of 

fluid extract of 

Convallamarin 

Convallaria, extract of 

fluid extract of 

Copaiba 

oil of 

Copper, acetate 

ammoniated 

sulphate, astringent, tonic . . . 

emetic 

Coptis, fluid extract of 

Corrosive sublimate. See Mercury. 
Corydalis, fluid extract of ... . 
Coto 

fluid extract of 

tincture of 

Cotoin 

Cotton-root bark. See Gossypium. 
Creasote 

water 

Creolin 

Croton-chloral hydrate 

Croton oil 

Cubebs 

fluid extract of 

oil of 

oleoresin of 

tincture of 

Curare 

Curarin 

Cypripedium 

fluid extract of 

Damiana, fluid extract of ... . 

tincture 

Daturine 

Delphinium, fluid extract of . . . 

Digitaline 

Digitalis, abstract of 

extract of 

fluid extract of 

infusion of 

powder of leaves of 

tincture of 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


2-10 min. 


0.10-0.60 cc. 


10-40 min. 


0.6-2.6 cc. 


10-40 min. 


0.6-2.6 cc. 


2-10 gr. 


0.12-0.6 gm. 


5-10 gr. 


0.3-0.6 gm. 


1-5 gr. 


0.06-0.3 gm. 


irl gi". 


0.005-0.01 gm. 


i-1 gr- 


0.015-0.06 gm. 


10-30 min. 


0.6-2.0 cc. 


eW* gr- 


0.001-0.002 gm. 


■h-h gr- 


0.001-0.002 gm. 


1-2 gr. 


0.06-0.12 gm. 


5 min. 


0.3 cc. 


5-1 gr- 


0.03-0.06 gm. 


1-2 min. 


0.05-0.10 cc. 


10-20 min. 


0.6-1.3 cc. 


1-2 gr. 


0.06-0.12 gm. 


1-5 min. 


0.05-0.3 cc. 


i-2 gr. 


0.03-0.12 gm. 


2-10 gr. 


0.12-0.6 gm. 


15-30 min. 


1.0-2.0 cc. 


20 min.-l fl. dr. 


1.3-4.0 cc. 


10-20 min. 


0.6-1.3 cc. 


i-i gr. 


0.015-0.03 gm. 


i~l gr- 


0.01-0.06 gm. 


i-5 gr. 


0.015-0.03 gm. 


5gr. 


0.3 gm. 


30-60 min. • 


2.0-4.0 cc. 


15-30 min. 


1.0-2.0 cc. 


5-15 gr. 


0.30-1.0 gm. 


5-15 min. 


0.3-1.0 cc. 


10-40 min. 


0.60-2.6 cc. 


tW gr- 


0.005-0.008 gm. 


1-3 min. 


0.05-0.20 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


% min. 


0.025 cc. 


2-10 gr. 


0.12-0.6 gm. 


^-1 min. 


0.025-0.05 cc. 


10 gr.-l dr. 


0.6-4.0 gm. 


10-60 min. 


0.6-4.0 cc. 


10-20 min. 


0.6-1.3 cc. 


5-20 min. 


0.3-1.3 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


j\-i gr. 


0.002-0.008 gm. 


1 1 -y,. 

64~S2 g 1 - 


0.001-0.002 gm. 


15-30 gr. 


1.0-2.0 gm. 


15-30 min. 


1.0-2.0 cc. 


30 min.-2 fl. dr. 


2.0-8.0 cc. 


1-3 fl. dr. 


4.0-12.0 cc. 


t^Wo gr- 


0.0006-0.0012 gm 


1-3 min. 


0.05-0.2 cc. 


■5o~z\ gr- 


0.0012-0.002 gm. 


1-2 gr. 


0.06-0.12 gm. 


i-5 gr- 


0.01-0.03 gm. 


1-6 min. 


0.05-0.40 cc. 


2-4 fl. dr. 


8.0-16.0 cc. 


5-2 gr. 


0.03-0.12 gm. 


5-30 min. 


0.3-2.0 cc. 



DOSES OF MEDICINES. 



827 



Remedy. 



Dioscorea, fluid extract of 

Dita, fluid extract of 

Dogwood, bark of root 

fluid extract of 

Donovan's solution. See Arsenic. 

Dover's powder 

Dracontium 

fluid extract of 

Drosera, fluid extract of 

Duboisine 

Dulcamara, extract of 

fluid extract of 

Elaterin 

Elaterium 

Emetin, diaphoretic 

emetic 

Ergot 

extract of 

fluid extract of 

tincture of 

wine of 

Ergotin, Bonjean's (purified extract of ergot) 

Erigeron, oil of 

Eriodictyon, extract of 

fluid extract of ........... . 

Ervthrophlcein 

Erythroxylon. See Coca. 

Eserine 

Ether, acetic 

compound spirit of (Hoffman's anodyne) 

nitrous, spirit of (sweet spirit of nitre) . 

sulphuric 

Ethyl bromide 

Eucalyptol 

Eucalyptus, fluid extract of 

oil of 

Euonymin 

Euonymus, extract of 

fluid extract of 

Eupatorium, fluid extract of 

.Euphorbia pilulifera, fluid extract of . . . 

Fel bovis purificatum 

Ferrum. See Iron. 

Frangula, fluid extract of 

Galls, aromatic syrup of 

fluid extract of 

tincture of . . 

-Gambir 

compound tincture of 

fluid extract of 

Gamboge . . 

Gaultheria, oil of 

Gelsemium, abstract of 

extract of 

fluid extract of . . . 

tincture of 

Gentian, compound infusion of 

extract of 

fluid extract of 

tincture of 

-Geranium, fluid extract of 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


15-30 min. 


1.0-2.0 cc. 


1-4 min. 


0.5-0.25 cc. 


20-60 gv. 


1.3-4.0 gm. 


30-60 min. 


2.0-4.0 cc. 


5-20 gr. 


0.3-1.3 gm. 


10-30 gr. 


0.6-2.0 gm. 


10-30 min. 


0.6-2.0 cc. 


5-10 min. 


0.3-0.6 cc. 


ro-o gr- 


0.0006 gm. 


30-60 gr. 


2.0-4.0 gm. 


£-1 fl. dr. 


2.0-4.0 cc. 


WG-T5 gi'- 


0.001-0.004 gm. 


1 1 ~ r 

n? g r - 


0.006-0.015 gm. 


T2'?5~'3 0" g r# 


0.0005-0.002 gm. 


i-i gr- 


0.008-0.015 gm. 


15-60 gr. 


1.0-4.0 gm. 


2-10 gr. 


0.12-0.6 gm. 


15 min.-l fl. dr. 


1.0-4.0 cc. 


£-2 fl. dr. 


2.0-8.0 cc. 


1-3 fl. dr. 


4.0-12.0 cc. 


2-8 gr. 


0.12-0.5 gm. 


5-15 min. 


0.3-1.0 cc. 


2-5 gr. 


0.12-0.3 gm. 


15-30 min. 


1.0-2.0 cc. 


tW gr- 


0.004-0.008 gm. 


tWxr gr- 


0.001-0.003 gm. 


10-20 min. 


0.6-1.3 cc. 


30 min. 


2.0 cc. 


|-1 fl. dr. 


2.0-4.0 cc. 


15-40 min. 


1.0-2.6 cc. 


15-60 min. 


1.0-4.0 cc. 


10-15 min. 


0.6-1.0 cc. 


15-30 min. 


1.0-2.0 cc. 


5-10 min. 


0.3-0.6 cc. 


2-5 gr. 


0.12-0.3 gm. 


1-3 gr. 


0.06-0.20 gm. 


i-1 fl. dr. 


2.0-4.0 cc. 


£-1 fl. dr. 


2.0-4.0 cc. 


5-30 min. 


0.3-2.0 cc. 


3-6 gr. 


0.20-0.40 gm. 


15-30 min. 


1.0-2.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


5-20 min. 


0.30-1.3 cc. 


£-2 fl. dr. 


2.0-8.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


£-2 fl. dr. 


2.0-8.0 cc. 


10-30 min. 


0.6-2.0 cc. 


i-4gr. 


0.03-0.25 gm. 


2-10 min. 


0.10-0.6 cc. 


1-2 gr. 
1-1 gr- 


0.06-0.12 gm. 


0.03-0.06 gm. 


2-5 min. 


0.10-0.3 cc. 


5-20 min. 


0.3-1.3 cc. 


1-4 fl. dr. 


4.0-8.0 cc. 


2-5 gr. 


0.12-0.30 gm. 


i-1 fl. dr. 


2.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


20-30 min. | 


1.3-2.0 cc. 



828 



DOSES OF MEDICINES. 



Remedy. 



Ginger, fluid extract of 

oleo-resin of . . . . 

tincture of 

Gland, suprarenal, dried 

thyroid, dried 

Glycyrrhiza. See Licorice. 

Goa powder 

Gold bromide 

Gold and sodium chloride 

Gossypium-root, fluid extract of bark of . 
Granati radicis cortex, fluid extract . . . 
Grindelia, fluid extract of ...... . 

Guaiac, ammoniated tincture of ... . 

resin of 

tincture of 

Guaiacol 

Guarana 

fluid extract of 

Gurjun. See Balsam. 

Hsematoxylon 

extract of 

fluid extract of 

Hamamelis, fluid extract of 

Hedeoma, oil of 

Helleborein 

Helleborus niger, extract of 

fluid extract of 

tincture of 

Hepatica. fluid extract ol ...... . 

Hexamethylenamine 

Hops, extract of 

fluid extract of 

tincture of . . . . . 

Hydrangea, fluid extract of 

Hydrastine . 

Hydrastis, extract of 

fluid extract of 

tincture of 

Hyoscine hydrobromide . 

Hyoscyamine sulphate 

Hyoscyamus, abstract of 

alcoholic extract of 

extract of 

fluid extract of flowers ........ 

of seeds 

tincture of flowers 

of seedf; 

of leaves 

Hypnal 

Hypnone 

Hypophosphites, syrup of 

with iron, syrup of 

Ichthyol 

Ignatia, abstract of 

extract of 

fluid extract of . 

tincture of 

Iodine, compound solution of 

tincture of 

Iodoform 

lodol 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


10-30 min. 


0.6-2 cc. 


1-3 min. 


0.06-0.20 jc. 


15-60 min. 


1.0-4.0 cc. 


2-5 gr. 


0.12-0.3 gm. 


£-5 gr. 


0.03-0.3 gm. 


5-20 gr. 


0.3-1.3 gm. 


M gr. 


0.008-0.03 gm. 


0.0015-0.003 gm. 


i-l fl. dr. 


2.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


|-1 fl. dr. 


2.0-4.0 cc. 


30-60 min. 


2.0-4.0 cc. 


10-20 gr. 


0.6-1.3 gm. 


30-60 min. 


2.0-4.0 cc. 


^-3 min. 


0.025-0.2 cc. 


10-30 gr. 


0.6-2.0 gm. 


10-30 min. 


0.6-2.0 cc. 


30-60 gr. 


2.0-4.0 gm. 


10-20 gr. 


0.6-1.3 gm. 


30-60 min. 


2.0-4.0 cc. 


30 min.-2 fl. dr. 


2.0-8.0 cc. 


2-5 min. 


0.10-0.3 cc. 


iHgr- 


0.006-0.015 gm. 


4-2 gr. 


0.03-0.12 gm. 


5-15 min. 


0.3-1.0 cc. 


10-30 min. 


0.6-2.0 cc. 


30-60 min. 


2.0-4.0 cc. 


5-20 gr. 


0.3-1.3 gm. 


3-15 gr. 


0.2-1.0 gm. 


30-60 min. 


2.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


30-60 min. 


2.0-4.0 cc. 


i~ig r - 


0.015-0.03 gm. 


3-10 gr. 


0.2-0.6 gm. 


10-30 min. 


0.6-2 cc. 


30-60 min. 


2.0-4.0 cc. 


TiyWo g r - 


0.0006-0.001 gm. 


T27~6 g r> 


0.0005-0.001 cm. 


2-3 gr. 


0.12-0 2 gm. 


1-2 gr. 


0.06-0.12 gm. 


2-3 gr. 


0.12-0.2 gm. 


5-15 min. 


0.3-1.0 cc. 


5 min. 


0.3 cc. 


15-30 min. 


1.0-2.0 cc. 


15-30 min. 


1.0-2.0 cc. 


10-30 min. 


0.6-2.0 cc. 


5-20 gr. 


0.3-1. gm. 


1-5 gr. 


0.06-0.3 gm. 


1 fl. dr. 


4.0 cc. 


1 fl. dr. 


4.0 cc. 


2-4 gr. 


0.12-0.25 gm. 


1-3 gr. 


0.06-0.2 gm. 


i-1 gr- 


0.015-0.06 gm. 


1-6 min. 


0.05-0.40 cc. 


5-15 min. 


0.3-1.0 cc. 


5 min. 


0.3 cc. 


2-4 min. 


0.1-0.25 cc 


1-3 gr. 


0.06-0.2 gm. 


i-* g^ 


0.03-0.12 gm. 



DOSES OF MEDICINES. 



829 



Remedy. 



Ipecacuanha, emetic . . . 

expectorant 

abstract of, emetic . . . 
fluid extract of, emetic . 

syrup of 

wine of, emetic . . . . 

expectorant 

I rid in or Irisin 

Iris, extract of 

fluid extract of . . . . 

Iron acetate, tincture of . . 

and ammonium citrate - 

sulphate 

tartrate 

arsenate 

benzoate 

bitter wine of 

bromide 

syrup of 

carbonate, saccharated . 
chloride 

tincture of 

and cinchonidia citrate . 

citrate 

compound mixture of . 
dialyzed 

solution of 

hydroxide of 

hypo phosphite 

syrup of* 

iodide 

syrup of 

lactate 

magnetic oxide of . . . 

inalate 

nitrate, solution . . . . 

phosphate 

pomate 

and potassium tartrate . 

pyrophosphate 

and quinia citrate . . . 

reduced 

saccharated carbonate of. 
and strychnine citrate . 

subcarbonate 

subsulphate 

sulphate . . 

dried 

valerianate 

wine of the citrate of. . 

Jaborandi, extract of . . . 

fluid extract of 



Dose. 



Apothecaries' 
Weights and Measures. 



Metric 
System. 



15-30 gr. 

4-1 gr. 

5-15 gr. 
15-30 min. 

i-1 fl. dr. 

3-6 fl. dr. 

5-15 min. 

1-5 gr. 

1-3 gr. 

5-15 min. 
15-30 min. 

5-10 gr. 

5-10 gr. 

5-15 gr. 

-5 gr. 

1-2 fl. dr. 

1-5 gr. _ 
15-60 min. 

5-15 gr. 

1-3 gr. 
10-30 min. 

5-10 gr. 

5-10 gr. 

1-2 fl. oz. 



i _ 

¥o • 

1- " 



alap 



abstract of 

compound powder of 

extract of 

alcoholic extract of . 
fluid extract of . . . 

resin of 

tincture of ... . 
Juglans, extract of . . 



10-30 min. 
Tablespoonful doses in 

5-10 gr. 
1 fl. dr. 

1-5 gr. _ 
10-30 min. 

1-5 gr. 

5-10 gr. 

5-15 gr. 

8-15 min. 

1-5 gr. 

5-15 gr. 
10-30 gr. 

2-5 gr. 

5-10 gr. 

3-6 gr. 

5-15 gr. 

1-3 gr. 

5-30 gr. 

1-3 gr. 

1-3 gr. 

i-2 gr. 

1-3 gr. 

i-l fl. dr. 

2-5 gr. 
10-60 min. 

5-30 gr. 

5-15 gr. 
I dr. 

5-10 gr. 

3-6 gr. 

5-30 min. 

4-8 gr. 

f-2 fl. dr. 

5-20 gr. 



1.0-2.0 gm. 

0.01-0.06 gm. 

0.3-1.0 gm. 

1.0-2.0 cc. 

2.0-4.0 cc. 
12.0-24.0 cc. 

0.3-1.0 cc. 
0.06-0.3 gm. 
0.06-0.2 gm. 

0.3-1.0 cc. 

1.0-2.0 cc. 

0.3-0.6 gm. 

0.3-0.6 gm. 

0.3-1.0 gm. 

0.0015-0.003 gm. 

0.06-0.3 gm. 

4.0-8.0 cc. 
0.06-0.3 gm; 

1.0-4.0 cc. 

0.3-1.0 gm. 
0.06-0.20 gm. 

0.6-2.0 cc. 

0.3-0.6 gm. 

0.3-0.6 gm. 
30.0-60.0 cc. 

0.3-1.0 cc. 

0.6-2.0 cc. 
arsenical poisoning. 

0.3-0.6 gm. 
4.0 cc. 
0.06-0.3 gm. 

0.6-2.0 cc. 
0.06-0.3 gm. 

0.3-0.6 gm. 

0.3-1.0 gm. 

0.5-1.0 cc. 
0.06 -0.3 gm. 

0.3-1 .Ogm. 

0.6-2.0 gm. 
0.12-0.3 gm. 

0.3-0.6 gm. 

0.2-0.4 gm. 

0.3-1.0 gm. 
0.06-0.20 gm. 

0.3-2.0 gm. 
0.06-0.20 gm. 
0.06-0.20 gm. 
0.03-0.12 gm. 
0.06-0.20 gm. 

2.0-4.0 cc. 
0.12-0.3 gm. 

0.6-4.0 cc. 

0.3-2.0 gm. 

0.3-1.0 gm. 
2.0 gm. 

0.3-0.6 gm. 
0.20-0.40 gm. 

0.3-2.0 cc. 
0.25-0.5 gm. 

2.0-8.0 cc. 

0.3-1.3 gm. 



830 



DOSES OF MEDICINES. 



Remedy. 



Juglans, fluid extract of ........ 

Juniperus, fluid extract of 

Kairin 

Kamala 

fluid extract of 

Kino 

fluid extract of 

tincture of ... 

Kola, fluid extract of 

Koosso. See Brayera. 

Krameria 

extract of 

fluid extract of 

syrup of 

tincture of 

Lactucarium 

fluid extract of 

syrup of 

Lappa, fluid extract of 

Lead acetate 

iodide 

Leptandra 

extract of 

fluid extract of 

Leptandriu . 

Lime, solution of 

syrup of • 

Liquor potassae, soda?, etc. See Potassa, 

Soda, etc. 
Liquorice, compound mixture of 

powder of .• 

Lithium benzoate . . . 

bromide 

carbonate 

citrate . • • 

salicylate 

Lobelia, fluid extract of 

tincture of 

Lupulin 

fluid extract of 

oleoresin of . . 

tincture of . 

Magnesia 

Magnesium carbonate 

oxide . 

sulphate • ■ 

effervescent ............ 

sulphite 

Male fern, oleoresin of 

Malt, extract of . 

Manganese dioxide, precipitated 

hypophosphite 

sulphate 

Manna 

Matico 

fluid extract of 

tincture of . . . ' 

Matricaria, fluid extract of . 

Menispermum, fluid extract of 

Menthol 

Mercury with chalk 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


1-2 fl. dr. 


4.0-8.0 cc. 


30-60 min. 


2.0-4.0 cc. 


2-10 gr. 


0.12-0.6 gm. 


i-1 dr. 


2.0-4.0 gm. 


30-60 min. 


2.0-4.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


10-30 min. 


0.6-2.0 cc. 


i-2 fl. dr. 


2.0-8.0 cc. 


10-30 min. 


0.6-2.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


20-30 min. 


1.3-2.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


|-2 fl. dr. 


2.0-8.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


10-30 min. 


0.6-2.0 cc. 


1-3 fl. dr. 


4.0-12.0 cc. 


30-60 min. 


2.0-4.0 cc. 


i-3 gr. 


0.03-0.20 gm. 


4-3 gr. 


0.03-0.20 gm. 


20-40 gr. 


1.3-2.6 gm. 


3-10 gr. 


0.20-0.6 gm. 


20-40 min. 


1.3-2.6 cc. 


2-4 gr. 


0.12-0.25 gm.. 


1-4 dr. 


4.0-16.0 cc. 


15-30 min. 


1.0-2.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


i-1 dr. 


2.0-4.0 gm. 


5-10 gr. 


0.3-0.6 gm. 


2-10 gr. 


0.12-0.6 gm. 


2-10 gr. 


0.12-0.6 gm. 


2-10 gr. 


0.12-0.6 gra- 


2-10 gr. 


ft 12-0. 6 gm. 


1-5 min. 


0.05-0.3 cc. 


10-30 min. 


0.6-2.0 cc. 


5-15 gr. 


0.3-1.0 gm. 


5-15 min. 


0.3-1.0 cc. 


2-5 gr. 


0.12-0.3 gm. 


\-2 fl. dr. 


2.0-8.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


10 gr.-l dr. 


0.6-4.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


2 dr.-l oz. 


8.0-30.0 gm.. 


£-1 oz. 


16.0-30.0 gm.. 


10-30 gr. 


0.6-2.0 gm. 


30 min.-l fl. dr. 


2.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


2-4 gr. 


0.12-0.25 gm.. 


2-5 gr. 


0.12-0.3 gm. 


2-10 gr. 


0.12-0.6 gm. 


1-2 oz. 


30.0-60.0 gm.. 


1-2 dr. 


2.0-8.0 gm. 


1-1 fl. dr. 


2.0-4.0 cc. 


|-2 fl. dr. 


2.0-8.0 cc. 


10-30 min. 


0.6-2.0 cc. 


30-60 min. 


2.0-4.0 cc. 


2 gr. 


0.12 gm. 


2-10 gr. 


0.12-0.6 gm. 



DOSES OF MEDICINES. 



831 



Remedy. 



Mercury, corrosive chloride of 

cyanide 

formamidate (1 per cent, solution) . . . 

green iodide of . . 

mass of (bine pill) 

mild chloride of 

red iodide of. . < 

salicylate 

tannate 

yellow subsulphate of 

Mezereum, extract of 

fluid extract of 

Morphine and its salts 

Morrhuol 

Musk 

tincture of 

Myrrh 

. tincture of 

Myrtol 

Naphthalene 

Naphthol m 

Narceine 

Narcotine 

Nectandra, fluid extract of 

Nitroglycerin (1 per cent, solution) . . . . 
Nux vomica, abstract of 

extract of 

fluid extract of 

tincture of 

Opium, camphorated tincture of (paregoric) 

confection of . . 

extract of 

powder 

tincture of (laudanum) 

wine of 

Pancreatin 

Papaver, extract of 

fluid extract of 

Papayotin 

Paracotoin 

Paraldehyde 

Pareira 

extract of 

fluid extract of 

tincture of 

Pelletierine sulphate 

tannate 

Peppermint, oil of 

spirit of 

Pepsin, pure 

liquor of 

saccharated 

Petroselinum, fluid extract of 

Phenacetin 

Phenol 

Phenyl, salicylate of 

Phosphorated oil . 

Phosphorus 

Physostigma, extract of 

fluid extract of 

tincture of 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


sWe gr- 


0.002-0.004 gm. 


tW gr. 


0.004-0.008 gm. 


5-15 min. 


0.3-1.0 cc. 


hi £r- 


0.01-0.03 cc. 


3-10 gr. 


0.2-0.6 gm. 


I- 5 g r - 


0.008-0.3 gm. 


sWe gr- 


0.002-0.004 gm. 


H gr- 


0.03-0.06 gm. 


2-1 gr- 


0.03-0.06 gm. 


J-l gr- 


0.015-0.06 gm. 


1-1 gr- 


0.03-0.06 gm. 


3-10 min. 


0.2-0.6 cc. 


tW gr- 


0.004-0.03 gm. 


1-5 min. 


0.05-0.3 cc. 


2-15 gr. 


0.12-1.0 gm. 


15-60 min. 


1.0-4.0 cc. 


3-10 gr. 


0.2-0.6 gm. 


15-30 min. 


1.0-2.0 cc. 


2-3 gr. 


0.12-0.20 gm. 


2-10 gr. 


0.12-0.6 gm. 


2-10 gr. 


0.12-0.6 gm. 


h\ gr- 


0.01-0.03 gm. 


3 gr. 


0.2 gm. 


1-4 fl. dr. 


4.0-16.0 cc. 


1 min. 


0.05 cc. 


i-1 gr. 


0.015-0.06 gm. 


i-a- gr- 


0.008-0.03 gm. 


1-5 min. 


0.06-0.3 cc. 


10-20 min. 


0.6-1.3 cc. 


i-2 fl. dr. 


2.0-8.0 cc. 


10-40 gr. 


0.6-2.6 gm. 


i i ™ r 
6 2 gr- 


0.01-0.03 gm. 


i~2 gr. 


0.015-0.3 gm. 


5-20 min. 


0.3-1.3 cc. 


5-20 min. 


0.3-1.3 cc. 


10-20 gr. 


0.6-1.3 gm. 


1-2 gr. 


0.03-0.12 gm. 


15-30 min. 


1.0-2.0 cc. 


1-5 gr. 


0.06-0.3 gm. 


1-3 gr. 


0.06-0.2 gm. 


20-60 min. 


1.3-4.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


10-30 min. 


0.6-2.0 cc. 


1 fl. dr. 


4.0 cc. 


2-5 gr. 


0.12-0.3 gm. 


1-5 gr. 


0.6-0.3 gm. 


2-5 min. 


0.10-0.3 cc. 


30-60 min. 


2.0-4.0 cc. 


15 gr.-l dr. 


1.0-4.0 gm. 


2-4 fl. dr. 


8.0-16.0 cc. 


30 gr.-| oz. 


2.0-16.0 gm. 


1-2 fl. dr. 


4.0-8.0 cc. 


2-5 gr. 


0.12-0.3 gm. 


4-1 gr- 


0.03-0.06 gm. 


5-20 gr. 


0.3-1.3 gm. 


3-5 min. 


0.2-0.3 cc. 


Th~i\ gr- 


0.0006-0.0008 gm. 


iW gr. 


0.004-0.01 gm. 


1-3 min. 


0.05-0.2 cc. 


10-20 min. 


0.6-1.3 cc. 



832 



DOSES OF MEDICINES. 



Remedy. 



Physostigmine salicylate 

sulphate 

Phytolacca, abstract of 

berries, fluid extract of 

root, extract of 

fluid extract of 

tincture of . . . . 

Phytolaccin 

Picrotoxin . 

Pilocarpine and its salts 

Pilocarpus, abstract of 

fluid extract of 

Pimenta, fluid extract of , 

Piper methysticum, fluid extract of. . 

nigrum, fluid extract of 

Piper nigrum, oleoresin of 

Piperine 

Piscidia erythrina, extract of ... . 

fluid extract of . . . . 

powder of 

Podophyllum, abstract of 

resin of • • • 

Pomegranate, bark of 

Poppy. See Papaver. 

Potassa, solution of (liquor potassse) . 

Potassium acetate 

bicarbonate 

bitartrate 

bromide 

carbonate 

chlorate ■ 

citrate . . 

solution of 

cyanide 

ferrocyanide 

hydroxide, solution of 

hypophosphite • 

iodide 

mixture of the citrate of ... . 

nitrate 

permanganate . . 

and sodium tartrate 

sulphate 

sulphide 

sulphite 

tartrate 

Prinos 

fluid extract 

Pulsatilla, fluid extract of 

Pyrethrum, tincture of 

Pyridine 

Pyrodine 

Quassia, extract of 

fluid extract of 

tincture of 

Quebracho, fluid extract of ... . 

Quercus, fluid extract of 

Quinidine 

Quinine and salts 

arsenate 

Quinoidin 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


tIo- h g r - 


0.0005-0.0008 gm. 


TZO~~JO g r - 


0.0005-0.0008 gm. 


5-15 gr. 


0.3-1.0 gm. 


5-30 min. 


0.3-2.0 cc. 


1-3 gr. 


0.06-0.2 gm. 


5-30 min. 


0.3-2.0 cc. 


10-60 min. 


0.6-4.0 gm. 


2-3 gr. 


0.12-0.2 gm. 


TsWs g r - 


0.001-0.002 gm. 


*W g r - 


0.001-0.03 gm. 


5-20 gr. 


0.3-1.3 gm. 


15-60 min. 


1.0-4.0 cc. 


15-45 min. 


1.0-3.0 cc. 


15 min.-l fl. dr. 


1.0-4.0 cc. 


15-45 min. 


1.0-3.0 cc. 


1-3 min. 


0.05-0.2 cc. 


1-8 gr. 


0.00-0.5 gm. 


1-2 gr. 


0.06-0.12 gm. 


10-30 min. 


0.6-2.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


1-5 gr. 


0.6-0.3 gm. 


i-i gr- 


0.008-0.03 gm. 


20-30 gr. 


1.3-2.0 gm. 


5-20 min. 


0.3-1.3 cc. 


15 gr.-l dr. 


1.0-4.0 gm. 


10-40 gr. 


0.6-2.6 gm. 


10-60 gr. 


0.6-4.0 gm. 


10 gr.-l dr. 


0.6-4.0 gm. 


5-30 gr. 


0-3-2.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


15-60 gr. 


1.0-4.0 gm. 


2-4 fl. dr. 


8.0-16.0 cc. 


tW gr- 


0.004-0.008 gm. 


10-15 gr. 


0.6-1.0 gm. 


5-20 min. 


0.3-1.3 cc. 


5-15 gr. 


0.3-1.0 gm. 


2-15 gr. 


0.12-1.0 gm. 


\ fl. oz. 


16.0 cc. 


5-15 gr. 


0.3-1.0 gm. 


1-2 gr. 


0.06-0.12 gm. 


i-1 oz. 


16.0-30.0 gm 


30 gr.-2 dr. 


2.0-8.0 gm. 


1-10 gr. 


0.06-0.6 gm. 


15-30 gr. 


1.0-2.0 gm. 


1 dr.-l oz. 


4.0-30.0 gm. 


30 gr.-l dr. 


2.0-4.0 gm. 


30-60 min. 


2.0-4.0 cc. 


2-5 min. 


0.10-0. 3 >cc. 


10-30 min. 


0.6-2.0 cc. 


1-3 gr. 


0.06-0.2 gm. 


1-3 gr. 


0.06-0.2 gm. 


1-5 gr. 


0.06-0.3 gm. 


30-60 min. 


2.0-4.0 cc. 


i-1 fl. dr. 


1.0-4.0 cc. 


20-60 min. 


1.3-4.0 cc. 


30-60 min. 


2.0-4.0 cc. 


1-30 gr. 


0.06-2.0 gm. 


1-30 gr. 


0.06-2.0 gm. 


i-1 gr- 


0.01-0.06 gm. 


10-30 gr. 


0.6-2.0 gm. 



DOSES OF MEDICINES. 



833 



Resorcinol . 

Rhamnus catharticus, fluid extract of . . 
Rhubarb 

aromatic syrup of 

tincture of . . . . 

compound powder of 

extract of 

fluid extract of 

and soda, mixture of 

sweet tincture of 

syrup of 

tincture of 

wine of 

Rhus, aromatic fluid extract of 

glabra (cortex), fluid extract of . . . 

(fructus), fluid extract of 

Rhus toxicodendron 

Roses, fluid extract of 

syrup of 

Rubus, fluid extract of 

Ruraex, fluid extract of . 

Ruta, fluid extract of 

Sabina, fluid extract of 

Saccharin 

Salicin 

Salix, fluid extract of 

Salol (phenyl salicylate) 

Salvia, fluid extract of - . . 

Sambucus, fluid extract of 

Sandal-wood, oil of 

Sanguinaria 

fluid extract of 

tincture of 

Santonica 

fluid extract of 

Santonin 

Sarsaparilla, compound fluid extract Of . 

compound syrup of 

fluid extract of 

Sassafras, fluid extract of ...... . 

Savine, oil of 

Saw palmetto 

fluid extract of ......... . 

Scammony 

resin of 

Scoparius, fluid extract of 

Scutellaria, fluid extract of 

Scutellarine 

Senega, abstract of 

fluid extract of 

syrup of 

Senna 

compound infusion of 

confection of 

fluid extract of 

infusion of 

syrup of 

tincture of 

Serpentaria, fluid extract of 

tincture of , 

Silver iodide 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


5-10 gr. 


0.3-0.6 gm. 


30-60 min. 


2.0-4.0 cc. 


5-40 gr. 


0.3-2.6 gm. 


1-4 fl. dr. 


4.0-16.0 cc 


4-1 fl. dr. 


2.0^.0 cc. 


4-1 dr. 


2.0-4.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


15-40 min. 


1.0-2.6 cc. 


1-2 fl. dr. 


2.0-8.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


15-60 min. 


1.0-4.0 cc. 


30-60 min. 


2.0-4.0 cc. - 


30-60 min. 


2.0-4.0 cc. 


1-6 min. 


0.05-0.4 gm. 


i-2 fl. dr. 


2.0-8.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


i-2 fl. dr. 


2.0-8.0 cc. 


30-60 min. 


2.0-4.0 cc. 


15-30 min. 


1.0-2.0 cc. 


5-15 min. 


0.3-1.0 cc. 


J-4 gr. 


0.03-0.25 gm. 


10-30 gr. 


0.6-2.0 gm. 


i-2 fl. dr. 


2.0-8.0 cc. 


5-20 gr. 


0.3-1.3 gm. 


4-2 fl. dr. 


2.0-8.0 cc. 


4-2 fl. dr. 


2.0-8.0 cc. 


10-20 min. 


0.6-1.3 cc. 


5-10 gr. 


0.3-0.6 gm. 


5-10 min. 


0.3-0.6 cc. 


10-40 min. 


0.6-2.6 cc. 


10-30 gr. 


0.6-2.0 gm. 


10-30 min. 


0.6-2.0 cc. 


1-4 gr. 


0.06-0.25 gm. 


4-2 fl. dr. 


2.0-8.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


4-2 fl. dr. 


2.0-8.0 cc. 


4-2 fl. dr. 


2.0-8.0 cc. 


2-5 min. 


0.10-0.3-cc. 


15-30 gr. 


1.0-2.0 gm. 


15-30 min. 


1.0-2.0 cc. 


5-15 gr. 


0.3-1.0 gm. 


2-10 gr. 


0.12-0.6 gm. 


• 4-1 fl. dr. 


2.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


1-3 gr. 


0.06-0.20 gm. 


4-10 gr. 


0.25-0.6 gm. 


8-15 min. 


0.5-1.0 cc. 


4-2 fl. dr. 


2.0-8.0 cc. 


1-2 dr. 


4.0-8.0 gm. 


1-2 oz. 


30.0-60.0 gm. 


1-2 dr. 


4.0-8.0 gm. 


l-2fl.dr. 


4.0-8.0 cc. 


4 fl. oz. 


120.0 cc. 


1-4 fl. dr. 


4.0-16.0 cc. 


2 fl. dr.-l fl. oz. 


8.0-30.0 cc. 


30 min.-l fl. dr. 


2.0-4.0 cc. 


4-2 fl. dr. 


2.0-8.0 cc. 


4-2 gr. 


0.03-0.12 gm. 



53 



834 



DOSES OF MEDICINES. 



Remedy. 



Silver nitrate 

oxide 

Simaruba, fluid extract of . 

Soda, solution of (liquor sodii hydroxidi) 
Sodium acetate 

arsenate . . 

exsiccated 

benzoate 

bicarbonate 

bisulphite 

borate 

bromide 

carbonate 

chlorate 

citrate 

hydroxide, solution of 

hypophosphite 

hyposulphite (thiosulphate) 

iodide 

nitrite 

phenolsulphonate (sulphocarbolate) . 

phosphate 

compound solution of 

exsiccated 

salicylate 

sulphate 

sulphite 

Sparteine sulphate 

Spigelia, fluid extract of 

and senna, fluid extract of 

Squill, compound fluid extract of . . . 
syrup of 

fluid extract of 

syrup of 

tincture of 

Stillingia, fluid extract of 

Stramonium, extract of 

fluid extract of 

leaves, alcoholic extract of .... . 
tincture of 

seeds, extract of . 

tincture of . 

Strontium bromide 

iodide . 

lactate 

phosphate 

salicylate 

Strophanthus, tincture of 

Strophantin 

Strychnine and its salts 

Sulphonal 

Sulphur 

Sumbul, fluid extract of 

tincture of 

Taraxacum, extract of 

fluid extract of 

Terebene 

Terpine hydrate 

Terpinol .... 

Thallin, sulphate of 

tartrate of 



Dose. 



Apothecaries' 
Weights and Measures. 



. M gr. 
i-1 gr. 
15-30 min. 
5-20 min. 
15 gr.-l dr. 

1-1 or 

6 0~To 5 1 - 

5-30 gr. 
10-30 gr. 
10-30 gr. 
10-30 gr. 
10-30 gr. 
10-30 gr. 

5-30 gr. 

1-10 dr. 

5-20 min. 

5-15 gr. 
10-30 gr. 

5-20 gr. 

1-4 gr. 

£-5 g r - 

i-2 dr. 

i-2 fl. dr. 
15-60 gr. 
10-20 gr. 

1-4 dr. 
10-30 gr. 

hi gr. 
15-60 min. 

i-2 fl. dr. 

5-15 min. 
15-30 min. 

5-15 min. 

i-l fl. dr. 

10-60 min. 

15-60 min. 

igr : 

1-4 min. 

1-1 err 

¥ 2 g r ' . 

8-15 min. 

H g^ 
6-15 min. 

20-30 gr. 

10-20 gr. 

20-30 gr. 

20-30 gr. 

5-20 gr. 

3-8 min. 

T2o"~"A g r - 

eWe gr. 

15-30 gr. 

1-3 dr. 
10-30 min. 
20-60 min. 

5-15 gr. 

l-l fl. dr. 

5-10 min. 

2-5 gr. 

tb gr- 
1-5 gr. 
1-5 gr. 



Metric 
System. 



0.015-0.03 gm. 
0.03-0.06 gm. 

1.0-2.0 cc. 

0.3-1.3 cc. 

1.0-4.0 gm. 

0.001-0.006 gm. 

0.0006-0.002 gm. 

0.3-2.0 gm. 

0.6-2.0 gm. 

0.6-2.0 gm. 

0.6-2.0 gm. 

0.6-2.0 gm. 

0.6-2.0 gm. 

0.3-2.0 gm. 

4.0-40.0 gm. 

0.3-1.3 cc. 

0.3-1.0 gm. 

0.6-2.0 gm. 

0.3-1.3 gm. 
0.06-0.25 gm. 
0.03-0.30 gm. 

2.0-8.0 gm. 

2.0-8.0 cc. 

1.0-4.0 gm. 

0.6-1.3 gm. 

4.0-16.0 gm. 

0.6-2.0 gm. 
0.008-0.002 gm. 

1.0-4.0 cc. 

2.0-8.0 cc. 

0.3-1.0 cc. 

1.0-2.0 cc. 

0.3-1.0 cc. 

2.0-4.0 cc. 

0.6-4.0 cc. 

1.0-4.0 cc. 
0.03 gm. 
0.05-0.25 cc. 
0.015-0.03 gm. 

0.5-1.0 cc. 
0.015-0.03 gm. 

0.4-1.0 cc. 

1.3-2.0 gm. 

0.6-1.3 gm. 

1.3-2.0 gm. 

1.3-2.0 gm. 

0.3-1.3 gm. 

0.2-0.5 cc. 

0.0005-0.001 gm. 

0.001-0.004 gm. 

1.0-2.0 gm. 

4.0-12.0 gm. 

0.6-2.0 cc. 

1.0-4.0 cc. 

0.3-1.0 gm. 

2.0-4.0 gm. 

0.3-0.6 cc. 

0.12-0.3 gm. 
0.003 gm. 

0.06-0.3 gm. 

0.06-0.3 gm. 



DOSES OF MEDICINES. 



835 



Remedy. 



Theine . . . 

Thuja, fluid extract of 

Thymol 

Toxicodendron, fluid extract of . . 

Triticum, fluid extract of 

Turpentine, oil of 

Urethane 

Ustilago maidis, fluid extract of . . 

Uva ursi, fluid extract of 

Valerian, abstract of 

ammoniated tincture of 

extract of 

fluid extract of 

oil of 

tincture of 

Veratrine 

Veratrum abstract of 

fluid extract of 

tincture of. 

Verbena, fluid extract of 

Viburnum, fluid extract of ... . 
Vinegar. See Acetum. 
Wahoo. See Euonymus. 

Wild-cherry bark 

Wild-cherry bark, fluid extract of . 

infusion of 

syrup of 

Wintergreen, oil of 

Wormseed, oil of . . . . • . . . . 
Xanthoxylum bark, fluid extract of. 

fruit, fluid extract of 

Zinc acetate 

bromide 

iodide 

oxide • 

phenolsulphonate 

phosphide 

sulphate (alterative) 

(emetic) 

syrup of iodide of 

valerianate 

Zingiber. See Ginger. 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


1-2 gr. 


0.06-0.12 gm. 


10-15 gr. 


0.6-1.0 gm. 


1-5 gr. 


0.06-0.3 gm. 


1-5 min. 


0.05-0.3 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


5-30 min. 


0.3-2.0 cc. 


10-30 gr. 


0.6-2.0 gm. 


15-60 min. 


1.0-4.0 cc. 


|-1 fl. dr. 


2.0-4.0 cc. 


10-15 gr. 


0.6-1.0 gm. 


i-2 fl. dr. 


2.0-8.0 cc. 


5-15 gr. 


0.3-1.0 gm. 


|-1 fl. dr. 


2.0-4.0 cc. 


4-5 min. 


0.25-0.3 cc. 


1-2 fl. dr. 


2.0-8.0 cc. 


eWo g r - 


0.001-0.003 gm. 


1-2 gr. 


0.06-0.12 gm. 


1-5 min. 


0.05-0.3 cc. 


10-20 min. 


0.6-1.3 cc. 


15-60 min. 


1.0-4.0 cc. 


1-2 fl. dr. 


4.0-8.0 cc. 


1-1 dr. 


2.0-4.0 gm. 


30-60 min. 


2.0-4.0 cc. 


1-2 fl. oz. 


30.0-60.0 cc. 


2-4 fl. dr. 


8.0-16.0 cc. 


1-20 min. 


0.05-1.3 cc. 


4-8 min. 


0.25-0.5 cc. 


15-30 min. 


1.0-2.0 cc. 


15-30 min. 


1.0-2.0 cc. 


1-2 gr. 


0.06-0.12 gm. 


1-2 gr. 


0.03-0.12 gm. 


i-3 gr. 


0.03-0.2 gm. 


2-8 gr. 


0.12-0.5 gm. 


i-2 gr. 


0.03-0.12 gm. 


2V-T0 gr- 


0.003-0.006 gm. 


i-1 gr. 


0.015-0.06 gm. 


10-30 gr. 


0.6-2.0 gm. 


20-40 min. 


1.2-2.5 cc. 


1-4 gr. 


0.06-0.2 gm. 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



AC. E. mixture, 186, 244 
Billroth's, 186 
Abdominal transfusion, 539 
Abortifacients, 39 
Abrin, 301 

Abrus precatorius, 301 
Absolute acetic acid, 59 

alcohol, 64, 70 
Absorption of drugs, 34 
Abstract of aconite, 63 
Abstracts, 26 
Acacia, 53 

mucilage of, 53 

syrup of, 53 
Acacise gummi, 53 
Aceta, 26 
Acetanilid, 53 

poisoning by, 56 
Acetanilidum, 53 
Acetate of ammonium, 80 

of lead, 306 

of morphine, 366 

of potassium, 58 

of sodium, 421 

of zinc, 458 
Acetic acid, 58 

Acetphenetidin (phenacetin), 378 
Acetum, 58 

ipecacuanhas, 292 

lobelise, 312 

opii, 365 

sanguinarise, 411 

scillse, 425 
Acid, cathartic, 417 

cinnamic, 198 

citric, 198 

ecbolic, 233 

ergotic, 233 

ergotinic, 234 

gallic, 254 

gelseminic, 256 

gentisic, 257 

hydrobromic, 270 

hydrochloride of quinine, 195 

infusion of cinchona, 197 
of roses, 402 

ipecacuanhic, 290 

lobelic, 311 

lupulinic, 268 

nitrate of mercury, 331 

nucleinic, 351 

phenic, 151 

phosphoric, 382 

picric, 386 



Acid, polygalic, 417 
ricinoleic, 157 
santominic, 412 
sclerotinic, 233 
sphacelinic, 234 
tartrate of potassium, 122 
trichloracetic, 448 
Acidum aceticum, 58 
dilutum, 59 
glaciale, 59 
arseniosum, 99, 105 
benzoicum, 119 
boricum, 124 
carbolicum, 151 

liquef actum, 155 
chronicum, 187 
citricum, 198 
galli cum, 254 

hydrobromicum dilutum, 131 
hydrochloricum, 270 

dilutum, 271 
hvdrocyanicum, 271 

dilutum, 271 
nitricum, 344 

dilutum, 345 
fumans, 345 
nitro-hydrochloricum, 271, 347 

dilutum, 271, 347 
phosphoricum concentratum, 382 

dilutum, 382 
salicylicum, 403 
sulphuricum, 433 

aromaticum, 434 
dilutum, 434 
tannicum, 438 
tartaricum, 441 
trichloraceticum, 448 
valerianicum, 453 
Acoine, 59 
Aconine, 60 
Aconite, 59 

liniment, 63 
ointment, 63 
poisoning by, 61 
Aconitina, 63 
Aconitine, 59, 63 

DuquesnePs crystalline, 63 
oleate, 62 
Aconitum napellus, 59 
Action of drugs, direct, 21 
duration of, 34, 35 
indirect, 21 
modes of, 21 
Acupuncture, 461 

(837) 



$38 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



Adeps benzoinatus, 120 

lame hydrosus, 303 
Administering drugs, modes of, 21 
Adonidin, 63 
Adonis vernalis, 63 
Adrenalin, 435 
^Ether, 237 

purificatus, 237 
Agaric, 63 
Agaricin, 63 
Alcohol, 64, 70 

absolutum, 64, 70 

administration of, 69 

amy li cum, 64 

contraindications to, 70 

dilutum, 64, 70 

ethylicum, 64 

phenylic, 151 
Alcoholism, acute, 67 

differentiation of, from apo- 
plexy, 68 
from opium poisoning, 68 
from paretic dementia, 69 

chronic, 68 
Ale, 71 
Alkaloids, 26 
Allis ether inhaler, 242 
Allium, 71 

-juice, 71 

sativum, 71 

syrup of, 71 
Allspice, 71 
Almond bread, 72, 552 

milk, 552 
Almonds, 72 

bitter, 72 

sweet, 72 
Aloe, 73 

Perryi, 73 

purificata, 74 

vera, 73 
Aloes, 73 

compound decoction of, 75 

contraindications to, 74 
Aloin, 73 
Aloinum, 73 
Alpha-eucaine, 247 
Alteratives, 39, 45 
Alum, 75 
Alumen, 75 

exsiccatum, 76 
Amber, 76 

American wormseed, 160 
Ammonia, 77 

liniment, 79 

-water, 79 

stronger, 79 
Ammoniac, 79 
Ammoniacum, 79 
Ammoniated liniment of camphor, .143 

mercury, 324 

tincture of ergot, 237 
of guaiac, 262 
of opium, 365 



Ammoniated tincture of quinine, 195 

of valerian, 453 
Ammonii acetas, 80 

benzoas, 80 

bromidum, 80 

carbonas, 81 

chloridum, 81 

iodidum, 82 

oxalas, 83 

phosphas, 83 

sulphas, 83 

valeras, 83, 453 
Ammonio-ferric alum, 293, 294 
Ammonium, 80 
Amygdala amara, 72 

dulcis, 72 
Amygdalin, 72, 396 
Amyl nitris, 83 

nitrite, 83 
Amylic alcohol, 64 
Amylopsin, 372 
Amylum, 426 
Ansesthesia bv infiltration, 202, 

203 
Anesthetics, 39, 45 
Anaphrodisiacs, 39 
Antacids, 39, 45 
Anthelmintics, 39, 45 
Anthrarobin, 85 
Antiarthritics, 39 

Antidotum arsenici, 108, 297, 313 
Antifebrin, 53 
Antihydrotics, 39 
Antimalarials, 46 
Antimonial powder, 85, 89 
Antimonii oxidum, 85 

et potassi tartras, 85, 86 

sulphidum, 85 

purificatum, 85 
Antimonium nigrum purificatum, 85 

sulphuratum, 85 

tartaratum, 85, 86 
Antimony, 85 

compound pill of, 89 

ointment of, 89 

wine of, 89 
Antiperiodics, 39, 46 
Antiphlogistics, 39 
Antipyretics, 46 
Antipyrin, 90 
Antipyrinum, 90 
Antiseptics, 46, 462 
Antispasmodics, 46 
Antistrepto coccus serum, 470 
Antitoxin, 467 

for diphtheria, 468 
Aphrodisiacs, 39 
Apiol, 96 
Apocynum, 96 

androsimsefolium, 96 

cannapinum, 96 
xApomorphina? hydrochloridum, 98 
Apomorphine, 97 
Apothecaries' measure, 29 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



839 



Apothecaries' weight, 29 
Aqua ammoniae, 79 
fortior, 79 

amygdalae amarae, 73 

camphorae, 143 

chloroform!, 182, 187 

cinnamomi, 198 

creosoti, 221 

hamamelidis, 265 

hydro genii dioxide, 273 

menthae piperitae, 375 

pimentae, 72 

rosae, 402 
Aquae, 26 
Arbutin, 452 
Argenti nitras, 340 
fusus, 341 
mitigatus, 344 
Argvria, 341 
Aristol, 98, 445 
Aristolochin, 418 
Arnica, 98 

montana, 98 
Arnicse flores, 99 

radix, 99 

rhizoma, 99 
Aromatic chalk powder, 139 

mixture of iron, 294 

powder, 156, 199 

spirit of ammonia, 79 

sulphuric acid, 434 

syrup of cascara, 157 
of rhubarb, 401 

tincture of rhubarb, 401 
Arsenate of iron, 294 

of sodium, 105 
Arseni iodidum, 105 

trioxidum, 99, 105 
Arsenic, 99 

trioxide, 99, 105 
Arsenicum, 99 
Arsenite of copper, 218 
Arsenous acid, 99 
Artificial milk, 553 
Asafetida, 109 
Asafcetida, 109 
Aspidium, 110 

filix-mas, 110 
Aspirin, 111 
Astringents, 40, 46 

mineral, 46 

vegetable, 46 
Atomization, 24 
Atropa belladonna, 112 
Atropina, 113 

Atropinae sulphas, 113, 118 
Atropine, 113 

oleate of, 118 
Auranine, 334 

Auri et sodii chloridum, 261 
Avoirdupois weight, 30 
Azedarach, 111 

decoction of, 111 

fluid extract of, 112 



.'DALM of Gilead," 449 

D Balsam of copaiba, 216 
Barbadoes aloes, 73 
Barium chloride, 112 
Barley-water, 551 
Barosma betulina, 133 
Basham's mixture, 293, 294 
Bath, Brand, 484 

cold, 477 

Russian, 508 

stretcher, 485 

Turkish, 505 
Bearberry, 452 
Beechwood creosote, 218 
Beef essence, 550 

peptonized, 547 

-tea, 550 
Beer, 71 
Belladonna, 112 

contraindications to, 119 

folia, 112 

leaves, 112 

liniment, 118 

ointment, 118 

plaster, 118 

poisoning by, 115 

radix, 112 

root, 112 

suppositories, 119 
Benzaconine, 60 
Benzoate of ammonium, 80 

of bismuth, 121 

of lithium, 311 
Benzoated lard, 120 
Benzoic acid, 119 
Benzoin, 119 
Benzoinated lard, 120 
Benzoinum, 119 
Benzonaphtol, 339 
Benzosulphanidum (saccharin), 403 
Berberine, 140, 269 
Beta-eucaine, 247 

-naphtol, 339 

-naphtol-bismuth, 339 
Bicarbonate of potassium, 395 

of sodium, 421 
Bichloride of mercury, 325 

as an antiseptic, 462 
Bidet, the, 475 

Billroth's A. C. E. mixture, 186 
Bimuriate of quinine and urea, 196 
Biniodide of mercury, 327 
Binoxide of manganese, 316 
Bismuth, 120 

and ammonium citrate, 120 

benzoate, 121 

carbonate, 120 

citrate, 120 

oxide, 120 

subcarbonate, 120 

subgallate, 120, 121 

subnitrate, 120 

subsalicylate, 120, 121 
Bismuthi et ammonii citras, 120 



840 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



Bismuthi carbonas, 120 

citras, 120 

oxidum, 120 

sub carbonas, 120 

subgallas, 120 

subnitras, 120 

subsalicylas, 120, 121 
Bisulphate of quinine, 195 
Bitartrate of potassium, 122 
Bitter almonds, 72 

wine of iron, 299 
Bitters, 40 
Black cohosh, 189 

draught, 417 

drop, 365 

ginger, 258 

mustard, 337 

oxide of manganese, 316 

pepper, 374 

snake-root, 189 

wash, 327 
Blaud's pill, 295 
Bleeding, 540 
Blistering collodion, 214 
Blisters, 490 

figures showing areas to apply, 491 
Blood-root, 411 
Blue-gum tree, 249 

-mass, 327 

ointment, 330 

pill, 327 
Bone-marrow, 259 
Boneset, 250 
Bonjean's ergotin, 236 
Borate of sodium, 123 
Borated lint, 124 
Borax, 123 

Boric acid, 123, 124, 467 
Boroglycerin, 124 
Bran bread, 552 
Brand bath, 484 
Brandy, 70 
Brayera, 223 

anthelmintica, 223 
Brometone, 125 
Bromide of ammonium, 80 

of calcium, 130, 137 

of ethyl, 131, 244 

of gold, 130 

of iron, 294 

of lithium, 131, 311 

of nickel, 131 

of potassium, 125 

of sodium, 131 

of strontium, 427 
Bromides, 125 

contraindications to, 130 
Bromine, 132 
Bromoform, 132 
Bronchitis, moist air inhalations in, 25 

tents, 518, 592 
Broom, 415 
Brown mixture, 310 
Brucine, 352 



Bryonia, 132 

alba, 132 

dioica, 132 
Bryony, 132 
Buchu, 133 

folia, 133 
Burgundy pitch, 393 
Butyl chloral hydras, 221 



riACODYLATE of iron, 295 
\J of sodium, 421 
Cactus grandiflorus, 134 

fluid extract of, 134 
tincture of, 134 
Caffea, 134 

Arabica, 134 
Caffeina, 134, 136 

citrata, 134 

effervescens, 135 
Caffeinae citras, 134 

effervescens, 135 
Caffeine, 134, 303 
Cajuput oil, 137 
Calabar bean, 385 
Calabarine, 385 
Calamine, 458 
Calcii bromidum, 130, 137 

carbonas prsecipitatus, 137 

chloridum, 137 

hydras, 141 

hypophosphis, 137 

phosphas, 137 

prsecipitatus, 137 

sulphas, 137, 139 
Calcined magnesia, 313 
Calcium, 137 

bromide, 130 

chloride, 137 

hypophosphite, 137 

lactophosphate, 139 

oxide, 140 
California buckthorn, 156 
Calomel, 327 

ointment, 330 
Calumba, 140 
Calumbse radix, 140 
Calumbine, 140 
Calx, 140 

chlorinata, 169 

sulphurata, 141 
Camphor, 141 

cerate, 143 

compound tincture of, 143 

liniment, 143 

monobromate, 143 

spirit of, 143 

-water, 143 
Camphora, 141 

monobromata, 143 
Camphorated alcohol, 143 

oil, 142 

tincture of opium, 364 
Camphoric acid, 144 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



841 



Canada pitch, 393 

plaster, 393 

turpentine, 449 
Cannabis indica, 145 

sativa, 145 
Cantharidal cerate, 149 

collodion, 149, 213 
Cantharidin, 147 
Cantharis, 147 

vesicatoria, 147 
Capsici fructus, 149 
Capsicine, 149 
Capsicum, 149, 494 

fastigiatum, 149 

fruit, 149 

plaster, 151 
Carbo ligni, 155 
Carbolic acid, 151 

as an antiseptic, 463 
ointment, 155 
poisoning by, 152 
Carbon, 155 
Carbonate of ammonium, 81 

of bismuth, 120 

of creosote, 220 

of guaiacol, 264 

of iron, 293, 295 

of lead, 307 

of lithium, 311 

of magnesium, 313 

of potassium, 395 

of zinc, 458 
Cardamom, 156 

seed, 156 
Cardamomi semina, 156 
Cardamomum, 156 
Cardiac sedatives, 40, 46 

stimulants, 40, 46 
Carminative powder, 198 
Carminatives, 40 
Carron oil, 141, 252 
Caryophyllum, 199 
Caryophyllus, 199 
Cascara cordial, 157 

evacuant, 157 

sagrada, 156 
Cassia fistula, 157 
Cassiae pulpa, 157 
Castile soap, 419 
Castor oil, 157 
Cataphoresis, 25 
Cataplasma carbonis, 155 

kaolini, 302 
Cataplasms, 26 
Catechu ; 159 
Cathartic acid, 417 
Cathartics, 40, 48 
Cat's-hair, 250 
Caustic potash, 159 

soda, 160 
Cayenne pepper, 149 
Cerates, 26 
Ceratum camphorae, 143 

cantharidis, 149 



Ceratum plumbi subacetatis, 308 

resinae compositum, 398 
Cerebral extracts, 259 
Cerii oxalas, 160 
Cerium oxalate, 160 
Chalk, 139 

mixture, 137, 139 
Chamber inhaler, 518 
Champagne, extra dry, 70 
Charcoal, 155 

poultice, 155 
Charta potassii nitratis, 340 

sinapis, 338 
Chartae, 26 
Chenopodium, 160 

ambrosioides, 160 

oil of, 160 . 
Chimaphila, 161 

umbellata 161 
Chinoidinum, 198 
Chirata, 161 
Chireta, 161 
Chloral, 161 

hydras, 162 

hydrated, 161 

poisoning by, 163 
Chloralf ormamide ( chloralf ormamidum), 

166 
Chloralose, 166 
Chlorate of potassium, 167 

troches of, 168 
Chloretone, 168 
Chloride of ammonium, 81 

of barium, 112 

of calcium, 137 

of ethyl, 245 

of gold and sodium, 261 

of iron, 293, 295 

of mercury > corrosive, 325 
mild, 327 

of methyl, 334 

of methylene, 335 

of sodium, 422 

of zinc, 459 

as an antiseptic, 466 
Chlorinated lime, 169, 498 
Chlorine gas, 170 
Chlorobrom, 166 
Chlorodyne, 170 
Chloroform, 170 

contraindications to, 183 

inhaler, Esmarch's, 180 

Krohne and Seseman's modifi- 
cations of Lawrie's, 182 
Lawrie's, 180 

liniment, 187 

-water, 182, 187 
Chloroformum, 170 

purificatum, 170 

venale, 170 
Cholagogues, 40 
Chromic acid, 187 
Chronium trioxide, 187 
Chrysarobin, 188 



842 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



Chrysarobin ointment, 188 
Chrysarobinum, 188 
Cimicifuga, 189 

racemosa, 189 

rhizoma, 189 
Cinchona, 190 

calisaya, 190 

flava, 190 

Ledgeriana, 190 

officinalis, 190 

pale, 190 

pitayensis, 190 

red, 190 

rubra, 190 

rubrae cortex, 190 

succirubra, 190 

yellow, 190 
Cinchonicine, 190 
Cinchonidinse sulphas, 196, 197 
Cinchonidine, 190, 197 

sulphate, 197 
Cinchonine, 190 
Cinnamic acid, 198 
Cinnamomi cortex, 197 
Cinnamomum camphora, 141 
Cinnamon, 197 

-water, 198 
•Citrate'of bismuth, 120 

and ammonium, 120 

of caffeine, 134 

of iron, 296 

and ammonium, 296 
and quinine, 296 
and strychnine, 296 

of lithium, 311 

of magnesium, 314 

of potassium, 395 
Citrated caffeine, 134 
Citric acid, 198 
Citrine ointment, 332 
Citrophen, 380 
Citrullus colocynthis, 213 
€larified honey, 268 
Classification of drugs, 45 
Claviceps purpura, 233 
Climates, 533 
Cloves, 198 
Clyster, 23 

Cobalto-nitrate of potassium, 346 
Coca, 199 
Cocse folia, 199 
Cocaina, 199 

Cocainae hydrochloridum, 199, 201 
Cocaine, 199 

habit, 206 

hydrochloride, 199, 201 
Cod-liver oil, 207 
Codeina, 206 
Codeinae phosphas, 206 
Codeine, 206, 357 

phosphate, 206 

sulphate, 206 
Coffee, 134, 210 
Colchiceine, 210 



Colchici cornus, 210 
semen, 210 
semina, 210 
Colchicine, 210, 213 
Colchicum. 210 
conn, 210 
seed, 210 
Cold bath, 477 
cream, 402 
in fevers, 480 
pack, 478 
as a remedv, 471 
Collodion, 212 

cantharidal, 149, 213 
flexible, 212 
styptic, 212 
Collodium, 212 

cantharidatum, 149, 213 
flexible, 212 
stypticum, 212, 439 
vesicans, 149, 213 
Colocynth, 213 
Colocynthidis pulpa, 213 
Colocynthine, 213 
Colocynthis, 213 
Cologne-water, 70 
Columba, 139 
Columbic acid, 140 
Columbine, 140 
Columbo, 139 

Combination of drugs for joint effect, 35 
Commercial oxide of zinc, 368 
Compound cathartic pill, 213 
cerate of resin, 398 
decoction of aloes, 75 
effervescing powder, 416 
elixir of kola, 303 
extract of colocynth, 213, 414 
fluid extract of sarsaparilla, 413 
infusion of gentian, 258 

of senna, 316, 417 
liniment of mustard, 338 
mixture of iron, 295 
of liquorice, 310 
of senna, 418 
pill of antimony, 89 
of calomel, 330 
of colocynth, 213 
of galbanum, 110 
of rhubarb, 400 
of scammony, 414 
of soap, 365 
of squill, 426 
powder of almonds, 72 
of catechu, 255 
of chalk, 139 
of cinnamon, 198 
of elaterin, 233 
of ipecac, 292, 365 
of jalap, 300 
of kino, 302 
of liquorice, 310, 418 
of morphine, 366 
of opium, 365 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



843 



Compound powder of rhubarb, 401 
of scammony, 414 
solution of iodine, 287 

sodium phosphate, 381 
.spirit of ether, 266 
of juniper, 301 
suppositories of lead, 307 
svrup of sarsaparilla, 413 

of squill, 89, 426 
tincture of benzoin, 119 
of camphor, 143, 364 
of cardamom, 156 
of catechu, 255 
of chloroform and morphine, 

187, 367 
of cinchona, 197, 419 
of gentian, 257 
of senna, 418 
Condurango, 214 
bianco, 214 
Confectio piperis, 374 
rosse, 268, 402 

gallicre, 402 
sennse, 157, 417, 438 
sulphuris, 433 
Confections, 26 
Conii folia, 214 

fructus, 214 
•Conine, 214, 215 

hydrobromide, 215 
Conium, 214 

maculatum, 214 
Conserves, 26 
Constipation, 615 
Contraindications for drugs, 39 
Convallamarin, 216 
Convallaria, 215 
majalis, 235 
Convolvulin, 300 
•Cool sponging, 480 
Co-ordinated movements for treating 

locomotor ataxia and myelitis, 488 
Copaiba, 216 
Copaifera Langsdorffi, 216 
Copper, 216 
Cornutine, 234 
Corrosive chloride of mercury, 325 

sublimate, 325 
Cosmoline, 378 
Cotarnine, 218 

hydro chlorate, 218 
Counterirritants, 41, 46 
Counterirritation, 490 
Coxe's hive syrup, 89, 417, 426 
Cream of tartar, 122 
Creolin, 221, 466 

as an antiseptic, 466 
Creosotal, 220 
Creosote, 218 

carbonate, 220 
inhaler, Yeo's, 219 
mixture, 220 
ointment, 220 
water, 220 



Creosotum, 218 
Cresol, 218 
Creta praeparata, 139 
Croton chloral, 221 

oil, 222 

liniment, 222 
Croup kettle, 519 
Cubeba, 222 
Cubebic acid, 222 
Cubebin, 222 
Cubebs, 222 

Cumulative action of drugs, 35 
Cupping, 495 
Cupri sulphas, 217 
Cuprum, 216 
Cups, dry, 495 

applied, 495 

wet, 495 
Curds and whev, 377 
Cusso, 223 
Cyanide of potassium, 223 



DANDELION, 440 
Datura stramonium, 427 
Daturine, 427 
Deadly nightshade, 112 
Decoction of azedarach, 111 

of chimaphila, 161 

of condurango, 214 
Decoctions, 26 
Decoctum aloes compositum, 75 

granati corticis, 395 

haematoxyli, 264 

scoparii, 416 
Definition of drugs, 39 

of therapeutics, 17 
Demulcents, 41 

Denison's resistance inhaler, 517 
Deodorized opium, 364 

tincture of opium, 365 
Dermatol, 121, 223 
Deshler's salve, 398 
Diabetin, 309 
Diachylon, 308 
Dialyzed iron, 296 
Diaphoretics, 41, 47 
Diastase, 224 

Diet for child one year old, 550 
seven years old, 549 
six to twelve months old, 

550 
two years old, 549 

importance of, in disease, 19 

lists, 549 
Dietetic treatment, importance of, 45 
Diethyl-sulphon-dimethyl-methane, 430 
Digestants, 47 
Digested gruel, 548 
Digitalein, 224 
Digitalin, 224 
Digitalis, 224 

contraindications to, 230 

folia, 224, 230 



844 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



Digitalis, poisoning by, 228 

purpurea, 224 
Digitalone, 232 
Digitin, 224 
Digitonin, 224 
Digitoxin, 224 
Dilute acetic acid, 59 

alcohol, 64, 70 

hydrobromic acid, 131 

hydrochloric acid, 271 

hydrocyanic acid, 271 

nitrate of silver, 344 

nitric acid, 345 

nitro-hydro chloric acid, 271, 347 

phosphoric acid, 382 

solution of subacetate of lead, 
308 

sulphuric acid, 434 
Diphtheria antitoxin, 468 
Direct action of drugs, 21 
Disease, elimination in, 19 

food in, 19 

relief of symptoms in, 20 

sleep in, 20 

treatment of, factors in, 19 
Disinfectants, 47 
Disinfection, 495 

Distilled extract of hamamelis, 265 
Diuretics, 41, 47 
Diuretin, 420 
DobelPs solution, 123 
Donovan's solution, 105 
Dorema ammoniacum, 79 
Dormiol, 232 
Dosage, 27 

hypodermic, 28 

by the rectum, 28 

rules of, 28 

Young's rule of, 28 
Dover's powder, 292, 365 
Dried alum, 76 

sulphate of iron, 299 
Drip-sheet, 478 
Drop, size of a, 28, 29 
Drugs, absorption of, 34 

classification of, 45 

combination of, for joint effect, 
35 

cumulative action of, 35 

duration of action, 35 

indications and contraindications 
for, 39 

modes of action of, 21 
of administering, 21 

strength and reliability of, 36 
Dry cups, 495 

applied, 495 

heat, 510 
Dryopteris filix-mas, 110 
Duboisia myoporoides, 232 
Duboisine, 232 

sulphate, 232 
Duquesnel's crystalline aconitine, 63 
Duration of action of drugs, 35 



ECBALLIUM elaterium, 233 
Ecbolic acid, 233 
Ecgonine, 199 

Effervescing citrate of caffeine, 
135 
of lithium, 311 
of magnesium, 315 
of potassium, 396 
draught, 396 
powder, 416 

sulphate of sodium, 423 
Egg-flip, 71 

-nog, 69 
Elaterin, 233 
Elaterinum, 233 
Elaterium, 233 
Electuaries, 26 
Elettaria repens, 156 
Elimination in disease, 19 
Eliminators, 41, 47 
Elixir adjuvans, 310 

ferri, quininae et strvchninae phos- 

phatum, 298 
kolae composita, 303 
phosphori, 385 
proprietatis, 75 
roborans, 197 
Elixirs, 26 
Emetics, 41, 47 

contraindications to, 41 
direct, 41, 47 
peripheral, 41, 47 
Emetine, 290, 292 
Emmenagogues, 42, 47 
direct, 42, 47 
indirect, 42, 47 
Emplastra, 26 
Emplastrum arnicae, 99 
asafoetidae, 110 
belladonnas, 118 
cantharidis, 149 
capsici, 151 
ferri, 299 
hydrargyri, 331 
menthol, 376 
opii, 365 
picis, 393 

burgundicae, 393 
canadensis, 393 
cantharidatum, 149, 393 
plumbi, 308 

iodidi, 307 
resinae, 308, 398 
saponis, 419 
Emulsin, 72, 397 
Emulsion of asafcetida, 110 
of bitter almonds, 72 
of cod-liver oil, 210 

with hypophosphites, 
210 
of sweet almonds, 72 
Emulsions, 26 
Emulsum amygdalae, 72 
asafoetidae, 110 



INDEX OF DBUGS AND BE ME DIAL MEASURES. 



845 



Emulsum chloroformi, 187 

olei morrhua?, 210 

cum hypophositibus, 210 
terebinthina?, 451 
E.idermic medication, 25 
Enema, 23 

nutrient, 23 

peptonized, 547 
Euteroclysis, 499 
Epispastics, 46, 490 
Ergot, 233 
Ergotic acid, 233 
Ergotin, 233, 236 

Bonjean's, 236 
Ergotinic acid, 234 
Ergotinum, 233, 236 
Erigeron, 236 

canadense, 236 
Erythrol tetranitrate, 237, 347 
Erythroxylon, 199 

coca, 199 
Escharotics, 46 
Eserine, 385, 386 

Esmarch's chloroform inhaler, 180 
Ether, 237 

contraindications to, 244 

inhaler, Allis, 242 
Ethyl alcohol, 64 

bromide, 244 

chloride, 245 

inhaler, 246 

iodide, 247 
Ethylate of sodium, 422 
Eucaine hvdrochlorate, 247 

lactate, 247 
Eucalyptol, 248 
Eucalyptus, 248 

globulus, 248 
Eudoxine, 249 
Euformol, 253 
Eugenia aromatica, 199 
Eugenol, 199 
Euonymi cortex, 249 
Euonymin, 249 
Euonymus, 249 

atropurpureus, 249 
Eupatorium, 250 

perfoliatum, 250 
Euphorbia pilulifera, 250 
Euphthalmin, 250 
Europhen 251 
Evans' pocket inhaler, 521 
Exalgine, 251 
Exercises for treating locomotor ataxia 

and myelitis, 458 
Expectorants, 42, 47 

sedative, 42, 47 

stimulating, 42, 47 
Exsiccated sodium phosphate, 381 
Extracts, 26 
Extractum aconiti, 63 
liquidum, 63 

aloes, 75 

barbadensis, 75 



Extractum belladonna alcoholicum 119 

foliorum, 118 

liquidum, 118 

radicis liquidum, 118 

viride, 119 
buchu liquidum, 134 
calumba* liquidum, 140 
cannabis indicse, 147 

liquidum, 147 
capsici liquidum, 151 
cascara? sagradse, 157 

liquidum, 157 
chirata? liquidum, 161 
cimicifugs\ 189 

liquidum, 189 
cinchona?, 197 

liquidum, 197 
coca?, 205 

liquidum, 205 
colchici cormi, 211 
colocynthidis, 213 

compositum, 213. 414 
conii, 215 
digitalis, 230 
ergotse, 236 

liquidum, 236 
euonymi, 250 

siccum, 250 
eupatorii liquidum, 250 
filicis liquidum, 111 
gentiana?, 258 
glycyrrhiza?, 310 

liquidum, 310 

purum, 310 
ha?matoxyli, 264 
hamamelidis liquidum, 265 
hydrastis liquidum, 270 
Iryoscyami, 275 
ipecacuanha^ liquidum, 292 
jaborandi liquidum, 391 
jalapae, 300 
leptandrae, 308 
nucis vomicae, 354 

liquidum, 354 
opii, 364 

liquidum, 365 
pareira? liquidum, 373 
physostigmatis, 386 
pilocarpi liquidum, 391 
podophylli, 394 
quassise, 398 
rhei, 400 

sarca? liquidum, 413 
stramonii, 427 
strophanthi, 429 
taraxaci, 440 

liquidum, 441 
uva ursi, 452 



FEEDING the sick, 542 
Fel bovinum purificatum, 368 
bovis, 367 

purificatum, 368 



846 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



Ferri et ammonii citras, 296 
sulphas, 293, 294 
tartras, 296 

arsenas, 294 

bromidum, 294 

cacodylas, 295 

carbonas saccharatus, 293, 295 

chloridum, 293, 295 

citras, 296 

hydroxidum, 297 

cum magnesia, 108, 297 

iodidum saccharatum, 297 

lactas, 299 

oxalas, 298 

phosphas, 298 
solubilis, 298 

et potassii tartras, 296 

pyrophosphas solubilis, 298 

et quininas citras, 296 
solubilis, 296 

et strychninse citras, 296 

reductum, 298 

subsulphas, 293, 298 

sulphas, 293, 299 
exsiccatus, 299 
granulatus, 299 

valeras, 299, 453 
Ferrum, 292 

dialysatum, 296 

reductum, 293, 298 

tartaratum, 296, 
Ferula fcetida, 109 
Fevers, cold in, 480 
Filix-mas, 110 
Flaxseed meal, 252 

oil, 252 

poultice, 252 

tea, 252 
Fleabane, 236 

Fleming's tincture of aconite, 63 
Flexible collodion, 212 
Flowers of sulphur, 431 
Fluid extract of azedarach, 112 

of cactus grandiflorus, 134 

of condurango, 214 

of hsematoxylon, 265 

of rhus aromatica, 401 

of solanum carolinense, 423 

of piscidia erythrina, 392 

extracts, 26 
Fluidextractum aconiti, 63 

belladonnas radicis, 118 

buchu, 134 

calumbas, 140 

cannabis indicas, 147 

capsici, 151 

chimaphilas, 161 

chiratas, 161 

cimicifugas, 189 

cinchonae, 198 

cocas, 205 

colchici seminis, 211 

conii, 215 

convallarise, 216 



Fluidextractum cubebas, 223 

cusso, 223 

digitalis, 230 

ergotas, 236 

eucalypti, 249 

eupatorii, 250 

gelsemii, 257 

gentianap, 258 

geranii, 258 

glycyrrhizas, 310 

granati, 395 

grindelise, 261 

hamamelidis foliorum, 265 

hydrastis, 270 

hyoscyami, 275 

ipecacuanhas, 292 

kolas, 303 

leptandras, 308 

lobelias, 312 

lupulini, 269 

nucis vomicas, 354 

pareiras, 373 

pilocarpi, 391 

podophylli, 394 

pruni virginian as, 397 

quassias, 398 

querci, 398 

rhamni purshianas, 157 

rhei, 401 

rhois glabra?, 401 

rosas, 402 

sabinas, 414 

sanguinarias, 411 

sarsaparillas, 413 

compositum, 413 

scillas, 425 

scopalas, 414 

senegas, 416 

sennas, 417 

serpentarias, 418 

spigelias, 424 

et sennas, 425 

stillingias, 427 

stramonii, 427 

strophanthi, 429 

taraxaci, 440 

uva ursi, 452 

Valeriana?, 453 

veratri, 456 

zingiberis, 258 
Flying blister, 490 
Food in disease, 19 

-materials, 544 
Foods for the sick, 542 
Formaldehyde, 252, 464 

generator, Novy's, 497 
Formaldehydum, 252 
Formic aldehyde, 252 
Fowler's solution, 104, 105 
Foxglove, 224 

Frazier-Lentz hot-air apparatus, 510 
Fumigation, 24 

lamp for mercurial, 319 
Fusel oil, 64 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



847 



GALLA, 254 
Gallic acid, 254 
ointment, 254 
Gambir, 159 
Garlic, 71 
Gaultheria, 255 
Gavage, 503 

method of employing, 503 
Gelsemii radix, 256 
Gelsemine, 256, 257 
Gelseminic acid, 256 
Gelsemium, 256 

poisoning by, 257 
General therapeutical considerations, 17 
Generator, Novy's formaldehyde, 497 
Gentian, 257 
Gentiana, 257 

lutea, 257 
Gentianae. radix, 257 
Gentianine, 257 
Gentisic acid, 257 
Geranium, 258 
German chamomile, 316 

soft soap, 419 
Germicides, 462 

Germs, mode of destroying, 462 
Gin, 70 
Ginger, 258 _ 
Glacial acetic acid, 59 
Glandulae suprarenales siccae, 436 

thyroidae siccae, 446, 448 
Glandular treatment, 259 
Glauber's salt, 422 
Glonoin, 346 
Glusidum, 403 
Glutol, 253 
Glycerin, 260 
Glycerins, 26 
Glycerinum, 260 

acidi borici, 124, 261 
carbolici, 155, 261 
tannici, 261, 439 

aluminis, 76, 261 

amyli, 260, 261 

boracis, 261 

pepsini, 261, 377 

plumbi subacetatis, 261, 308 

tragacanthae, 261 
Glycerita, 26 
Glycerites, 26 

Glyceritum acidi carbolici, 155 
tannici, 439 

amyli, 260 

boroglycerini, 124 

hydra stis, 270 

phenolis, 155 

vitelli, 260 
Glvcerole of aloes, 74 
Glyceryl nitrate, 347 
Glycyrrhiza, 310 
Glycyrrhizae radix, 310 
Glycyrrhizinum ammoniatum, 310 
Goa powder, 188 
Gold, 261 



Gold, bromide of, 130 

Golden seal, 269 

Gonolobus condurango, 214 

Goodell's pill of the threevalerianates,453 

sumbul pill, 434 
Goulard's extract, 307 
Graduated medicine glasses, 29 
Granati cortex, 394 
Granatum, 394 
Granulated citrate of magnesium, 314 

opium, 364 

sulphate of iron, 299 
Gray oil, 321, 330 

powder, 330 
Green extract of belladonna, 119 

soap, 419 
Griffith's mixture, 295 

pills, 295 
Grindelia, 261 

robusta, 261 
Gruel, digested, 548 
Guaiac, 262 

resin, 262 
Guaiaci resina, 262 
Guaiacol, 262 

carbonate, 264 
Guaiacum, 262 

officinale, 262 
Gum acacia, 53 

arabic, 53 



HvEMATOXYLI lignum, 264 
Haematoxylin, 264 
Haematoxylon, 264 
Hamamelidis cortex, 265 

folia 265 
Hamamelis, 265 

virginiana, 265 
Heat, 504 

dry, 508 
Heavy magnesia, 313 
Hemlock fruit, 214 

juice, 214 

leaves, 214 
Henbane, 275 
Heroin, 265 

hydrochloride, 266 
Hexamethylenamine (urotropin, uri- 

tone), 452 
Hoffmann's anodyne, 266 
Holocaine, 266 

hydrochloride, 266 
Homatropinae hydrobromidum, 267 
Homatropine, 267 

Home modification of Turkish bath, 507 
Honey, 267 

of borax, 124, 268 

of rose, 268, 402 

of squill, 426 
Hop poultice, 269 
Hope's camphor mixture, 268 
Hops, 268 
Horse-nettle, 423 



848 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



Hot-air apparatus, Frazier-Lentz, 510 
Kelley's, 511 

pack, 509 

springs, 531 
House mixture, 519 
Humulus, 268 
Husband's magnesia, 313 
Huxham's tincture, 197, 418 
Hydragogue cathartics, 48 
Hydrargyri chloridum corrosivum, 325 
mite, 327 

iodidum navum, 332 
rubrum, 327 

oleas, 331 

oxidum flavum, 332 
rubrurn, 332 

perchloridum, 325 

subchloridum, 327 

subsulphas flavus, 333 
Hydrargyrum, 317 

ammoniatum, 324 

cum creta, 330 
Hydrastine, 269, 270 
Hydrastinine hydrochloride, 270 
Hydrastis, 269 

canadensis, 269 

rhizome, 269 
Hydrate of chloral, 161 

of lime, 141 
Hydrated sesquioxide of iron, 108, 297 
Hydriodide of scopolamine, 415 
Hydrobromic acid, 131, 270 
Hydrobromide of conine, 215 

of homatropine, 267 

of hyoscine, 276 

of hyoscyamine, 275 

of pelletierine, 394 

of quinine, 195 

of scopolamine, 414 
Hydrochlorate of eucaine, 247 
Hydrochloric acid, 270 
Hydrochloride of apomorphine, 98 

of cocaine, 199 

of cotarnine, 218 

of heroin, 266 

of holocaine, 266 

of hydrastinine, 270 

of methylthionine (methylene blue), 
335 

of morphine, 366 

of pelletierine, 394 

of phenocoll, 380 

of pilocarpine, 391 

of quinine, 195 
acid, 195 

of scopolamine, 414 

of strychnine, 355 
Hydrocyanic acid, 271 
Hydrogen peroxide, 273, 369 

as an antiseptic, 466 
Hydroxide of iron, 297 

with magnesia, 108 

of potassium, 159 

of sodium, 160 



Hvoscinae hydrobromidum, 276 
Hyoscine, 275, 276 

hydrobromide, 276 
Hyoscyami folia, 275 
Hyoscyaminae hydrobromidum, 275 

sulphas, 275 
Hyoscyamine, 275 
Hyoscyamus, 275 

leaves, 275 
Hypnal, 277 
Hypnotics, 42, 48 

Hypodermic injection of apomorphine, 98 
of cocaine, 206 
of ergot, 236 
of morphine. 367 

medication, 22, 28 
Hypodermoclysis, 511 

apparatus for, and method of per- 
forming, 512 
Hypophosphite of calcium, 137 

of manganese, 316 
Hyposulphite of sodium, 422 



TCE-BAG, 474 
1 -coil, 474 

-jacket, 472 

-poultice, 472 

-rub, 481 
Ichthyol, 277 
Idiosyncrasy, 28, 37 
Imperial measure, 30 
Incompatibility, 43 
Indian hemp, 145 

poke, 454 
Indications for drugs, 39 
Indirect action of drugs, 21 
Infiltration anaesthesia, 202 

method of producing, 202, 203 
Infusion of juniper, 302 

of matricaria, 316 
Infusions, 26 
Infusum brayerae, 223 

buchu, 134 

calumbae, 140 

caryophylii, 199 

chiratae, 161 

cinchonae, 197 
acidum, 197 

columbae, 140 

digitalis, 230 

ergotae, 236 

gentianae compositum, 258 

lupuli, 269 

pruni virginianae, 397 

quassias, 398 

rhei, 401 

rosaa acidum, 402 

scoparii, 416 

senegae r 417 

sennae, 418 

compositum, 316, 417 

serpentariae, 418 

uvae ursi, 452 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



849 



Inhalations, 24, 513 

exercises to be used in, 514, 515 
Inhaler, Allis ether, 242 
chamber, 518 

Denison's resistance, 517 

Esmarch's chloroform, 180 

ethyl chloride, 247 

Evans' pocket, 521 

menthol, 521 

Yeo's creosote, 219, 521 
Injectio cocainse hypodermica, 206 

ergotae hypodermica, 236 

morphinse hypodermica, 367 

opomorphinae hypodermica, 98 
Inspissated ox-gall, 367 
Intravenous injection, 524 
Inunctions, 25 
Iodide of ammonium, 82 

of arsenic, 105 

of ethvl, 247 

of iron, 297 

of lead, 307 

of potassium, 279 

of sodium, 282 

of strontium, 427 

of thymol, 445 
Iodine, 282 

contraindications to, 281 

ointment, 287 

poisoning by, 283 
Iodoform, 287 

as an antiseptic, 464 

ointment, 289 

poisoning by, 287 
Iodoformum, 287 
Iodol, 289 
Iodothyrine, 448 
Iodum, 282 
Ipecac, 290 
Ipecacuanha, 290 
Ipecacuanhae radix, 290 
Ipecacuanhic acid, 290 
Ipomcea purga, 300 
Iron, 292 

aromatic mixture of, 294 

arsenate of, 294 

bromide of, 294 

cacodylate of, 295 

carbonate of, 295 

chloride of, 295 

citrates of, 296 

dialyzed, 296 

by hydrogen, 293 

hydroxide with magnesia, 108 

iodide of, 297 

lactate of, 299 

oxalate of, 298 

phosphates of. 298 

plaster, 299 

reduced, 298 

subsulphate of, 297 

sulphate of, 299 

tartrates of, 296 

valerate of, 299 



Iron, wines of, 299 
Isopilocarpine, 387 



TABORANDI folia 387 
t) Jaborine, 387 
Jalap, 300 
Jalapa, 300 
Jalapin, 300, 414 
Jamaica dogwood, 392 
James' powder, 89 
Jamestown weed, 427 
Jequirity, 301 
Jervine, 454 

Joint effects of drugs, 35 
Juniper, 301 
Juniperin, 301 
Juniperus, 301 
Junket, 553 



KAMALA, 302 
Kaolin, 302 

cataplasm of, 302 
Kaolimim, 302 
Kataphoresis, 25, 524 
Kelene, 247 

Kelley's hot-air apparatus, 511 
Kermes mineral, 85 
Kinic acid, 190 
Kino, 302 

Kinotannic acid, 302 
Kinovic acid, 191 
Kola, 302 

Kolatannic acid, 303 
Koosin, 223 
Koumyss, 549 
Kousso, 223 
Kreolin, 221, 466 



LACTATE of eucaine, 247 
of iron, 299 

of strontium, 427 
Lactophenin, 380 
Lactophosphate of calcium, 139 
Lactose, 429 

Lady Webster dinner pills, 75 
Lamellae atropine, 118 

cocainae, 205 

homatropinae, 267 

physostigminae, 386 
Lanolin 303 
Lard, benzoated, 120 
Laudanine, 357 
Laudanum, 365 
Laughing gas, 349 
Lavage, 524 

methods of performing, 526 
Lavements, 23 
Laxatives, 48 
Lead, 303 

acetate, 306 

carbonate, 307 



54 



850 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



Lead, iodide, 307 

nitrate, 308 

oxide, 308 

plaster, 308 

-water and laudanum, 307 
Ledoyen's disinfectant solution, 308 
Leeches, 527 

application of, 528 
Leeching, 527 

therapeutics of, 528 
Lemon-juice, 198 
Leptandra, 308 
Leptandrin, 309 
Leptandrine, 309 
Levant wormseed, 411 
Levulose, 309 
Light magnesia, 313 
Lignum vitse, 262 
Lime, 140 

chlorinated, 169 

sulphurated, 141 

-water, 140 
Lingual traction, 241 
Lini farina, 252 

semina, 252 
Liniments, 26 
Linimentum aconiti, 63 

ammoniae, 79 

belladonnae, 118 

calcis, 141, 252 

camphorae, 143 

ammoniatum, 143 

chloroformi, 187 

crotonis, 222 

hydrargyri, 331 

mollis, 419 

opii, 365 

plumbi subacetatis, 308 

potassii iodidi cum sapone, 282 

saponis, 143, 419 

sinapis, 338 

compositum, 338 

terebinthinae, 451 
aceticum, 452 
Linseed, 252 

oil, 252 

poultice, 252 
Linum, 252 
Lipanin, 309 
Liquid petrolatum, 378 
Liquor acidi arsenosi, 104, 105 
chromici, 188 

ammoniae, 79 
fortis, 79 

ammonii acetatis, 80 
citratis, 83 

arseni et hydrargyri iodidi, 105 

arseni calis, 104, 105 

arseni ci hydro chloricus, 105 

atropinae sulphatis, 118 

bismuthi et ammonii citratis, 120 

calcis, 140, 141 

chlorinatse, 170 
saccharatus, 141 



Liquor calumbae concentratus, 140 
carbonis detergens, 646 
chiratae concentratus, 161 
cresolis compositus, 313 
epispasticus, 149 
ferri acetatis, 299 

et ammonii acetatis, 293, 294 

chloridi, 296 

citratis, 296 

perchloridi, 296 
fortis, 296 

persulphatis, 297 

subsulphatis, 297 

tersulphatis, 108 
formaldehydi, 253 
hamamelidis, 265 
hydrargyri nitratis, 331 
acidus, 331 

perchloridi, 326 
hydrogenii peroxidi, 273 
iodi compositus, 287 

fortis, 287 
magnesii carbonatis, 314 

citratis, 314 
morphinae acetas, 367 

hydro chloridi, 367 

sulphatis, 366 

tartratis, 367 
pancreatis, 372 
pepsini, 377 
plumbi subacetatis, 307 
dilutus, 308 
fortis, 307 
potassae, 310 
potassii arsenitis, 104, 105 

citratis, 395, 396 

permanganatis, 378 

potassii hydroxidi, 310 
quassiae concentratus, 398 
rhei concentratus, 401 
sarsae compositus concentratus, 413 
sennae concentratus, 418 
sodii arsenatis, 105 

ethylatis, 422 

hydroxidi, 160 

phosphatis compositus, 381 
strychninae hydro chloridi, 355 
thyroidei, 448 
trinitrini, 347 
zinci chloridi, 459 
Liquorice, 310 
root, 310 
Liquors, 27 
Litharge, 308 
Lithia-water, 311 
Lithii benzoas, 311 

bromidum, 130, 311 
carbonas, 311 
citras, 311 

effervescens, 311 
salicylas, 311 
Lithium, 311 

bromide, 130 
Liver, 259 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



851 



Lobelia, 311 

Lobelic acid, 311 

Lobeline, 311 

Lofoten cod-liver oil, 207 

Logwood, 264 

Lotio hydrargyri flava, 333 

nigra, 327 
Lozenges, 27 
Lugol's solution, 287 
Lunar caustic, 341 
Lung expansion, arrangement of bottles 

for promoting, 517 
Lupulin, 268, 269 
Lupuline, 268 
Lupulinic acid, 268 
Lupulinum, 269 
Lupulus, 268 
Lycetol, 312, 392 
Lycopodium, 312 
Lysol, 313 



MAGEN DIE'S solution, 366 
Magnesia, 313 
levis, 313 
ponderosa, 313 
Magnesii carbonas, 313 

ponderosa vel levis, 313 

citras, 314 

effervescens, 314 
oxidum ponderosum, 313 

sulphas, 314 

effervescens, 315 
Magnesium, 313 
Male fern, 110 
Mammary gland, 315 
Mandrake, 393 
Manganese, 316 
Mangani dioxidum praecipitatum, 31 

hypophosphis, 316 

sulphas, 316 
Manganum, 316 
Manna, 316 
Marsden paste, 104 
Massa copaibse, 216 

ferri carbonatis, 295 

hydrargyri, 327 
Matricaria, 316 

infusion of, 316 
May apple, 393 
Meadow saffron, 210 
Measures, weights and, 30 
Meconic acid, 357 
Meconine, 357 
Medication by cataphoresis, 25 

endermic method, 25 

fumigation, 21 

hypodermic injection, 22 

inhalation, 24 

inunction, 25 

mouth, 21 

rectum, 23 
Medicine glasses, graduated, 29 
Mel, 267 



Mel boracis, 124, 268 

depuratum, 268 

rosae, 268, 402 
Melaleuca leucodendron, 136 
Melia azedarach, 111 
Mentha piperita, 374 
Menthol, 317, 375 

inhaler, 521 
Mercurial fumigator, 319 

ointment, 330 
diluted, 331 

oleate, 331, 332 

pills, 327 

plaster, 331 
Mercurol, 317 
Mercurv, 317 

bichloride, 325 

biniodide, 327 

with chalk, 330 

ointment, 330 

protiodide, 332 

salicylate, 332 
Metadioxybenzol, 398 
Methyl acetanilid, 251 

blue, 333 

chloride, 334 

salicylas, 255 

violet, 333 
Methylene blue (methylthionine hydro- 
chloride), 335 

chloride, 336 

mixture, 187 
Methylenum cceruleum, 335 
Methylthionine hydrochloride (methyl- 
ene blue), 335 
Metric equivalents, 31, 32 

system of weights and measures, 
31, 32 
Mild chloride of mercury, 327 
Milk, almond, 552 

artificial, 553 

of asafoetida, 110 

peptonized, 546 

-punch, 69 

peptonized, 547 

-sugar, 429 

of sulphur, 432 
Mineral astringents, 46 

cathartics, 48 

springs, 530 
Mint camphor, 375 

stearopten, 375 
Mistura ammoniaci, 79 

amygdala, 72 

creosoti, 220 

cretse, 137, 139 

ferri aromatica, 294 
composita, 295 

glycyrrhizse composita, 310 

guaiaci, 262 

olei ricini, 159 

potassii citratis, 396 

rhei et sodas, 401 

sennae composita, 418 



852 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



Mistura spiritus vini gallici, 71 
Mitigated caustic, 344 
Mixtures, 27 
Modes of action of drugs, 21 

of administering drugs, 21 
Monkshood, 59 
Monobromated camphor, 143 
Monochloral-antipvrin, 277 
Monsel's salt, 293," 297 

solution, 297 
Morphina, 366 
Morphinae acetas, 366 

hydro chloridum, 366 

sulphas, 366 

tartras, 366 
Morphine, 357, 366 
Moschus, 336 
Mouth, administration of drugs by the. 

21 
Mucilage of acacia, 53 
Mucilago acaciae, 53 
Mulled wine, 70, 553 
Muriate of ammonium, 81 

of morphine, 366 
Musk, 336 
Mustard, 337 

papers, 338 

plaster, 337, 494 
Mydriatics, 42 
Myotics, 42 
Myristica, 351 
Myrrh, 338 
Myrrha, 338 
Myrrhin, 338 



NAPHTHALENE, 338 
Naphthalin, 338 
Naphthalinum, 338 
Naphthol, 339 
Naphtol, 339 
Narceine, 357 
Narcotine, 357 
Nargol, 339, 467 
Nebulizer, Oliver's, 523 

Robertson's, 522 
Nebulizers, 375, 522 
Nervous sedatives, 42, 48 

stimulants, 42, 48 
Neutral mixture, 395, 396 
Nickel, bromide of, 131 
Nitrate of lead, 308 

of mercury, 331 

of pilocarpine, 391 

of potassium, 340 

of silver, 340, 467 
Nitre, 340 
Nitric acid, 344 
Nitrite of amyl, 83 

of potassium, 345 

of sodium, 346 
Nitrogen monoxide, 349 
Nitroglycerin, 346 
Nitro-hydrocnioric acid, 271, 347 



Nitrous oxide, 349 

contraindications to, 350 
Normal saline solution, 537 
Norwood's tincture of veratrum viride, 

456 
Nosophen, 351 

Novy's formaldehyde generator, 497 
Nuclein, 351 

contraindications to, 351 
Nucleinic acid, 351 
Nut-gall, 254, 438 
Nutmeg, 351 
Nutrient enema, 23 
Nux vomica, 352 



AATMEAL- WATER, 551 
U Oil of amber, 76 

of garlic, 71 

of rue, 402 

of tar, 439 

of vitriol, 433 
Ointment of aconitine, 63 

of ammoniated mercury, 324 

of ntimony, 89 

of atropine, 119 

of belladonna, 118 

of boracic acid, 124 

of calomel, 330 

of cantharides, 149 

of capsicum, 151 

of carbolic acid, 155 

of chrysarobin, 188 

of cocaine, 206 

of conium, 215 

of creosote, 220 

of eucalyptus, 249 

of gallic acid, 254 

of galls, 254 

with opium, 254 
of hamamelis, 265 
of iodide of lead, 307 

of potassium, 282 
of iodine, 287 
of iodoform, 289 
of lead acetate, 307 

carbonate, 307 
of mercurv, 330 

diluted, 331 
of nitrate of mercury, 332 
of oxide of zinc, 368 

phenol, 155 
of red iodide of mercury, 327 

oxide of mercury, 332 
of resin, 398 
of rose-water, 402 
of salicylic acid, 408 
of stramonium, 427 
of sulphur, 432 
of tannic acid, 439 
of tar, 440 

of tartrate of antimony, 89 
of turpentine, 451 
of veratrine, 454 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



853 



Ointment of yellow oxide of mercury, 
332 

Ointments, 27 

Oleate of aconitine, 62 

of atropine, 118 

of cocaine, 201 
Oleatum atropine, 118 

cocainae, 201 

hydrargyri, 331, 332 

veratrinae, 454 
Oleoresina aspidii, 111 

capsici, 151 

cubebae, 223 

lupulini, 269 

piperis, 374 

zingiberis, 258 
Oleum am} T gdal3?, 72 

amarse, 72 

expressum, 72 

eajuputi, 136 

caryophilli, 199 

chenopodii, 160 

cinereum, 321, 330 

cinnamomi, 198 

copaibae, 216 

crotonis, 222 

cubebae, 223 

erigerontis, 236 

eucalypti, 248 

gaultheriae, 256 

jecoris aselli, 207 

juniperi, 302 

lini, 252 

menthae piperita?, 375 

morrhuae, 207 

myristicae, 351 

pimentae, 71 

piscis liquidae, 439 

phosphoratum, 385 

ricini, 157 

sabinae, 413 

santali, 410 

sinapis volatile, 337 

succini, 76 

tanaceti, 439 

terebinthinae, 449 

rectiflcatum, 450 

tiglii, 222 

Valerianae, 452 
Oliver's nebulizer, 523 
Opium, 356 

deodoratum 364 

granulatum, 364 

poisoning, acute, differentiation of, 
from acute alcoholism, 68 
Opodeldoc, 419 
Orphol, 339 
Orthoform, 367 
Ouronparia gambier, 255 
Ovarian extract, 259, 367 
Oxalate of ammonium, 83 

of cerium, 160 

of iron, 298 
Ox-gall, 367 



Oxide of antimony, 85 

of bismuth, 120 

of calcium, 140 

of lead, 308 

of magnesium, 313 
heavy, 313 

of mercurv, 332 

of zinc, 368 
Oxygen, 369 

apparatus, 370 

-water, 369 
Oxymel, 268 

scillae, 426 
Oxytoxics, 42, 48 
Oysters, peptonized, 547 



PACK, hot, 509 
Pale cinchona, 191 
rose, 402 
Pancreas, 259 
Pancreatin, 371 
Pancreatinum, 371 
Papain, 372 
Papaverine, 357 
Papayotin, 372 
Papers, 25 
Papoid, 372 
Paraldehyde, 373 
Paraldehydum, 373 
Paregoric, 364 
Pareira, 373 
Pareirae radix, 373 
Parsley, 96 

Pearson's solution, 105 
Pelletierine, 394 

tannate, 395 
Pepo, 373 
Pepper, 374 
Peppermint, 374 

-water, 375 
Pepsin, 376 

cordial, 377 
Pepsinum, 376 

saccharatum, 377 
Peptonized beef, 547 
enema, 547 

milk, 546 

-punch, 547 

oysters, 547 
Permanganate of potassium, 377 
Peroxide of hydrogen, 273, 369, 466 
Persulphate of iron, 297 
Petrolatum, 378 

album, 378 

liquidum, 378 

molle, 378 

spissum, 378 
Petroselinum, 96 
Phenacetin (acetphenetidin), 378 
Phenacetinum (acetphenetidinum), 378 
Phenazone, 90 
Phenazonum, 90 
Phenic acid, 151 



854 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



Phenocoll, 380 

hydrochloride, 380 
Phenol, 151 

glycerite of, 155 

ointment of, 155 
Phenolis, glyceritum, 155 

unguentum, 155 
Phenolsulphonate (sulphocarbolate) 
sodium, 381 

of zinc, 381 
Phenyl-acetamide, 54 

-dimethyl-pyrazolon, 90 

-salicylate (salol), 409. 
Phenylic alcohol, 151 
Phlebotomy, 540 
Physostigma, 385 
Physostigmatis semina, 385 
Physostigmine salicylas, 386 

sulphas, 386 
Physostigmine, 385 
Phosphate of ammonium, 83 

of codeine, 206 

of iron, 298 

of sodium, 381 

of strontium, 427 
Phosphorated oil, 385 
Phosphoric acid, 382 
Phosphorus, 382 
Picea, 393 
Picric acid, 387 
Pill of three valerianates, 453 
Pills, 27 
Pilocarpine hydro chloridum, 391 

nitras, 391 
Pilocarpine, 387 
Pilocarpus, 387 

Pilula colocynthidis composita, 213 
et hyoscyami, 213 

galbani composita, 110 

hydrargyri, 327 

subchloridi composita, 330 

ipecacuanhe cum scilla, 292 

plumbi cum opio, 307 

quininse sulphatis. 195 

saponis composita, 365 

scammonii composita, 414 
Pilule aloes, 74 

et ferri, 75 

et mastiches, 75 

et myrrhe, 74, 338 

antimonii composite, 89 

asafcetide, 110 

cathartice composite, 213 
vegetabiles, 213 

ferri, 295 

carbonatis, 295 

iodidi, 297 

laxative composite, 75 

opii, 364 

phosphori, 385 

quinine sulphatis, 195 

rhei, 400 

composita, 400 
compositus, 400 



of 



Pilule scille composita, 426 
Pimenta, 71 
Pinkroot, 424 
Piper, 374 

cubeba, 222 

nigrum, 374 
Piperazine, 391 
Piperin, 374 
Piperinum, 374 
Pipsissewa, 161 
Piscidia erythrina, 392 
Piscidine, 392 
Pitch, 392 
Pix, 392 

burgundica, 393 

canadensis, 393 

liquida, 439 
Piaster of arnica, 99 

of asafcetida, 110 

of belladonna, 118 

of Burgundy pitch, 393 

of Canada pitch, 393 

of cantharides, 149 

of capsicum, 151 

of iodide of lead, 307 

of iron, 299 

of lead, 308 

of menthol, 376 

of mercury, 331 

of opium, 365 

of pitch, 393 

of resin, 308, 398 

of soap, 419 
Plasters, 26 
Plumbi acetas, 304 

carbonas, 307 

iodidum, 307 

nitras, 308 

oxidum, 308 
Plumbum, 303 
Plummer's pills, 89 
Podophyllin, 393 
Podophyllum, 393 
Poke-root, 454 
Polygalic acid, 417 
Pomegranate, 394 
Port wine, 71 
Porter, 71 
Potash papers, 340 
Potassa caustica, 160 

cum calce, 140, 160, 457 
Potassii acetas, 58 

bicarbonas, 395 

bitartras, 122 

bromidum, 125 

carbonas, 395 

chloras, 167 

citras, 395 

effervescens, 396 

cyanidum, 223 

hydroxidum, 159 

iodidum, 279 

nitras, 340 

permanganas, 377 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



8b5 



Potassii et sodii tartras, 401 

tartras acidus, 122 
Potassium acetate, 58 

bicarbonate, 395 

bitartrate, 122 

bromide, 125 

carbonate, 395 

chlorate, 167 

citrate, 395 

cobalto-nitrite, 346 

cyanide, 223 

hydroxide, 159 

iodide, 279 

nitrate, 340 

nitrite, 345 

permanganate, 377 

silicate, 418 
Poultice of charcoal, 155 
Precipitated carbonate of calcium, 137 
of zinc, 458 

dioxide of manganese, 316 

phosphate of calcium, 137 

sulphur, 401 
Prepared chalk, 139 
Prescription, parts of a, 51 

writing, 49 
Pride of China, 111 
Protargol, 396, 467 
Protiodide of mercury, 332 
Protoxide of nitrogen, 349 
Pruni virginianae cortex, 396 
Prunus virginiana, 396 
Prussic acid, 271 
Pseudomorphine, 357 
Psychotria ipecacuanha?, 290 
Pulvis acetanilidi compositus, 58 

amygdalae compositus, 72 

antimonialis, 85, 89 

aromaticus, 156, 198 

catechu compositus, 255 

cinnamomi compositus, 198 

cretae aromaticus, 139 
cum opio, 139 
compositus, 139 

effervescens compositus, 416 

elaterini compositus, 233 

glycyrrhizae compositus, 310, 418 

ipecacuanha? compositus, 292, 365 
et opii, 292, 365 

jalapae compositus, 300 

kino compositus, 302 

morphinae compositus, 366 

opii, 356, 364 

compositus, 365 

rhei compositus, 401 

scammonii compositus, 414 

soda? tartaratae effervescens, 416 
Pumpkin-seed, 373 
Punch, milk-, 70 
Punk, 63 
Purgatives, 48 
Purging cassia, 157 
Purified aloes, 74 

chloroform, 170 



Purified ox-gall, 368 

sulphide of antimony, 85 
Pyoktanin, 333, 397 
Pyrogallic acid, 397 
Pyrogallol, 397 
Pyrophosphate of iron, 298 



QUASSIA. 397 
infusion of, 398 
Quassiae lignum, 397 
Quassin, 397 
Queen's root, 426 
Quercus, 398 

Lusitanica, 254 

tinctoria, 398 
Quevenne's iron, 293, 298 
Quicksilver, 317 
Quinicine, 190 
Quinidinae sulphas, 197 
Quinidine, 190 

sulphate, 197 
Quinina, 190 
Quininae bimuriatica carbamas, 196 

bisulphas, 195 

hydrobromidum, 195 

hydro chloridum, 195 
acidum, 195 

sulphas, 195 

valeras, 195, 453 
Quinine, 190 

acid hydrochloride of, 195 

bisulphate, 195 

chocolates, 195 

hydrobromide, 195 

hydrochloride, 195 

tannate, 195 

sulphate, 195 

and urea, bimuriate of, 196 

valerianate. 195 



RASPBERRY, 402 
Rectal medication, 23, 28 
Rectified spirit, 71 
Red cinchona, 190 

iodide of mercury, 327 

oxide of mercury, 332 

precipitate, 332 
ointment, 332 

rose, 402 

wine, 70 
Reduced iron, 293, 298 
Reliability and strength of drugs, 36 
Remedial measures other than drugs, 461 
Remedv, cold as a, 471 
Resin, 398 

cerate, 398 

compound of, 398 

of guaiac, 262 

ointment, 398 

plaster, 308 
Resina, 398 

jalapae, 300 



856 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



Resina podophylli, 394 

scammonii, 414 
Resistance inhaler, Denison's, 517 
Resorcinol, 398 
Respiration-indicator, Krohne and Sese- 

mann's, 371 
Rest cure, 528 

in the treatment of disease, 20 
Restorative beef-essence, 550 
Revulsives, 42 
Rhamnus purshiana, 156 
Rhei radix, 400 
Rheum, 400 
Rhigolene, 400 
Rhubarb, 400 
Rhus aromatica, 401 

glabra, 401 
Rice-water, 551 
Ricinoleic acid, 157 
Ricinus communis, 157 
Robertson's nebulizer, 522 
Roborants, 42 
Rochelle salt, 401 
Rosa gallica, 402 

gallicse petala, 402 
Rose-water, 402 
Rosin, 398 
Rottlera, 302 
Rottlerin, 302 
Rubefacients, 46, 493 
Rubus idseus, 402 
Rue, 402 

Rules for dosage, 27 
Rum, 70 
Russian bath, 508 



OABINA, 413 

k3 Saccharated carbonate of iron, 295 
iodide of iron, 297 
pepsin, 377 
solution of lime, 141 
Saccharin (benzo-sulphanidum), 403 
Saccharum, 429 

lactis, 429 

purificatum, 429 
Sal prunella, 340 
Salicin, 403 . 
Salicinum, 403 
Salicylate of bismuth, 121 

of lithium, 311 

of mercury, 332 

of methyl, 255, 409 

of phenyl (salol), 409 

of physostigmine, 386 

of sodium, 409 

of strontium, 427 
Salicylic acid, 403 

poisoning by, 404 

ointment, 408 
Salol (phenyl salicylate), 409 
Salophen, 410 
Salophenum, 410 
Salt, 422 



Saltpetre, 340 
Salts, 314 

Sandalwood oil, 410 
Sanguinaria, 411 
Sanguinarine, 411 
Santonica, 411 
Santonin, 411 

poisoning by, 412 
Santoninate of sodium, 412 
Santoninic acid, 412 
Santoninum, 411 
Sapo, 419 

durus, 419 

mollis, 419 
Sarsae radix, 413 
Sarsaparilla, 413 
Savine, 413 
Scammonia radix, 414 
Scammonise resinee, 414 
Scammonium, 414 
Scammony, 414 
Schleich's anaesthetic mixture, 

fluid, 202 
Scilla, 425 
Scillin, 425 
Scillipicrin, 425 
Scillitoxin, 425 
Sclerotinic acid, 233 
Scoparii cacumina, 415 
Scoparin, 415 
Scoparius, 415 
Scopola, 414 
Scopolamine, 414 

hydriodide, 414 

hydrobromide, 414 

hydrochloride, 414 
Sedatives, cardiac, 40, 46 

nervous, 42, 48 

vasomotor, 43, 49 
Seidlitz powder, 416 
Senega, 416 
Senegse radix, 416 
Senegin, 416 
Senna, 417 

Alexandrina, 417 

confection of, 157 

Indica, 417 
Serpentaria, 418 
Serpentaria? rhizoma, 418 
Serum antidiphtheritic, 468 

antistreptococcus, 470 
Sherry, 71 

Sick, feeding the, 542 
Silicate of potassium, 418 

of sodium, 418 
Silver nitrate, 340, 467 
Sinapis alba, 337 

albse semina, 337 

nigra, 337 

nigrse semina, 337 
Sinapisma, 338 
Slaked lime, 141 
Sleep in disease, 20 
Smilax, 413 



187 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



857 



Smooth sumach, 401 
Snake- weed, 250 
Soap, 419 

liniment, 143, 419 

plaster, 419 
Socotrine aloes, 73 
Soda caustica, 160 

tartarata. 401 
Sodii acetas, 421 

arsenas, 105 

bicarbonas, 421 

boras, 122 

bromidum, 131 

chloridum, 422 

hydroxidum, 160 

hyposulphis (thiosulphas), 423 

iodidum, 282 

nitris, 346 

phenolsulphonas, 381 

phosphas, 381 

effervescens, 381 
exsiccatus, 381 

et potassii tartras, 401 

salicylas, 409 

santoninas, 412 

sulphas, 422 

effervescens, 423 

sulphoearbolas, 381 

tartarata, 401 

thiosulphas (hyposulphis), 423 
Sodio-theobromine salicylate, 420 
Sodium, 421 

arsenate, 105 

bicarbonate, 421 

borate, 123 

bromide, 131 

cacodylate, 421 

chloride, 422 

ethylate, 422 

hydroxide, 160 

hyposulphite (thiosulphate), 423 

iodide, 282 

nitrite, 346 

phenolsulphonate, 381 

phosphate, 381 

effervescing, 381 
exsiccated, 381 

salicylate, 409 

santoninate, 412 

silicate, 418 

sulphate, 422 

sulpho-carbonate, 381, 430 

thiosulphate (hyposulphite), 423 
Soft petrolatum, 378 
Solanum Carolinense, 423 
Soluble citrate of iron and quinine, 290 

glass, 418 

phosphate of iron, 298 
Solution of acetate of ammonium, 80 
of iron, 299 
of morphine, 367 

of ammonia, 79 

of arsenate of sodium, 105 

of arsenic and mercuric iodide, 105 



Solution of arsenite of potassium, 105 
of arsenous acid, 104, 105 
of carbonate of magnesium, 314 
of chloride of iron, 296 

of zinc, 459 
of chlorinated lime, 170 
of chromic acid, 188 
of citrate of ammonium, 83 

of bismuth and ammonium, 120 
of iron, 296 
of magnesium, 314 
of potassium, 395 
of hydrochloride of morphine, 367 

of strychnine, 355 
of iodide of arsenic and mercury, 105 
of iodine, 287 
of iron and ammonium acetate, 293, 

294 
of lime, 140, 141 
of nitrate of mercury, 331 
of pancreas, 372 
of pepsin, 377 
of perchloride of iron 296 

of mercury, 326 
of permanganate of potassium, 378 
of potassa, 310 
of potassium hydroxide, 310 
of silicate of sodium, 419 
of sodium hydroxide, 160 
of subacetate of lead, 307 
of sulphate of atropine, 118 
of iron, 297 
of morphine, 366 
of tartrate of morphine, 367 
of tersulphate of iron, 108 
Somnal, 423 
Sozoidol, 424 
Spanish fly, 147 
Sparteine sulphas, 415 
Sparteine, 415 
Sphacelinic acid, 234 
Spice plaster, 494 
Spigelia, 424 

Spinal anaesthesia, mode of introducing 
the needle in, 192 
extracts, 259 
Spirit of Mindererus, 80 
of nitrous ether, 436 
of turpentine, 450 
Spirits, 27 
Spiritus setheris, 244 

compositus, 266 
nitrosi, 436 
ammoniae, 79 

aromaticus, 79 
fcetidus, 79 
cajuputi, 137 
camphorse, 143 
chloroformi, 182, 187 
einnamomi, 198 
frumenti, 70 
gaultherise, 256 
glycerylis nitratis, 347 
juniperi, 302 



858 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



Spiritus juniperi compositus, 70, 301 
menthse piperita?, 375 
myristicse, 351 
odoratus, 70 
phosphori, 385 
restificatus, 71 
vini gallici, 70 
Sponging, cool, 480 
Sprays, atomized, 24, 25 
Springs, mineral, 530 
Squill, 425 

Squirting cucumber, 233 
Starch, 426 

glycerite of, 260 

poultice, 426 

-water, 426 
Steam vaporizer, 520 
Steapsin, 372 
Stillingia, 426 
Stillingin, 426 
Stimulants, cardiac, 40, 46 

nervous, 42, 48 

vasomotor, 43, 49 
Stomach-pump, 527 
Stout, 70 
Stramonii, 427 
Stramonium, 427 
Strength, relative, of drugs, 36 
Stretcher, bath, 484 
Strong gray ointment, 330 
Stronger water of ammonia, 79 
Strontium, 427 

bromide, 131, 427 

iodide, 427 

lactate, 427 

phosphate, 427 

salicylate, 427 
Strophanthi semina, 428 
Strophanthin, 428, 429 
Strophanthus, 428 
Strychninse sulphas, 355 
Strychnine, 352 

hydrochloride, 355 

sulphate, 355 
Strychnos nux vomica, 352 
Styptic collodion, 212, 439 
Stypticin, 218 
Styrax benzoin, 119 
Subcarbonate of bismuth, 120 
Subgallate of bismuth, 121 
Sublimed sulphur, 431 
Subnitrate of bismuth, 120 
Subsulphate of iron, 293, 298 
Succinum, 76 
Succus belladonnse, 119 

conii, 215 

hyoscyami, 275 

limonis, 198 

scoparii, 416 

taraxaci, 440 
Sugar, 429 

-beet, 429 

-cane, 429 

of lead, 306 



Sugar of milk, 429 

Sulphate of aluminum and potassium, 75 

of ammonium, 83 

of atropine, 113, 118 

of calcium, 137, 139 

of cinchonidine, 196 

of cinchonine, 197 

of codeine, 206 

of copper, 216 

of duboisine, 232 

of hyoscyamine, 275 

of iron, 293, 299 

and ammonium, 293, 294 

of magnesium, 314 

of manganese, 316 

of morphine, 366 

of pelletierine, 394 

of physostigmine, 386 

of quinidine, 197 

of quinine, 195 

of sodium, 422 

of sparteine, 415 

of strychnine, 355 

of zinc, 459 
Sulphide of antimony, 85 

of calcium, 433 
Sulphocarbolate (phenolsulphonate) of 
sodium, 381 

of zinc, 381, 467 
Sulphonal (sulphonmethane), 430 
Sulphonalum, 430 

Sulphonethylmethanum (trional), 449 
Sulphonmethanum (sulp'ional), 430 
Sulphur, 431 

lotum, 431 

ointment, 433 

praecipitatum, 431 

sublimatum, 431 
Sulphurated antimony, 85 

lime, 141 
Sulphuric acid, 433 

ether, 237 
"Sulphuric acid lemonade," 434 
Sumach, smooth, 401 

sweet, 401 
Sumbul, 434 

pill, Goodell's, 434 

radix, 434 
Suppositoria acidi tannici, 439 

asafcetidee, 110 

belladonnse, 119 

glycerini, 260 

iodoformi, 289 

morphinae, 367 

plumb i composita, 307 
Suppositories, 24, 27 
Suppositorium acidi carbolici, 155 
Suprarenal gland, 259, 435 
Suspension, 536 
Swamp hellebore, 454 
Sweet almonds, 72 

spirit of nitre, 436 

sumach, 401 
Swertia chirate, 161 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



859 



Sydenham's laudanum, 365 
Symptoms, relief of, in disease, 20 
Syrups, 27 
Syrupus acaciae, 53 
acidi citrici, 198 
allii, 71 
amygdalae, 72 
calcii lactophosphatis, 139 
cascarae aromaticus, 157 
chloral, 165 
codeinae, 207 
ferri bromidi, 295 
iodidi, 297 
phosphatis, 298 

cum quininaetstrvchnina, 
298 
quininae et strychninae phos- 
phatum, 298 
hypophosphitum, 139 

compo situs, 139 
ipecacuanhas, 292 
limonis, 198 
piscis liquidae, 440 
pruni virginianae, 397 
rhei, 401 

aromaticus, 401 
rosae, 402 
rubi idaei, 402 

sarsaparillae compositum, 413 
scillae, 426 

compositus, 89, 426 
senegae, 416 
sennae, 418 
zingiberis, 258 



TABELL./E trinitrini, 347 
Tables of relative weights and 
measures in the metric and apoth- 
ecaries' systems, 33 
Tablet triturates, 27 
Tablets, 27 

of nitroglycerin, 347 
Taeniin, 223 
Taka-cLiastase, 224 
Tamarinds, 438 
Tamarindus, 438 
Tanacetum, 439 
Tannate of pelletierine 395 

of quinine, 195 
Tannic acid, 438 
Tansy, 439 

tea, 439 
Tar, 439 

ointment, 440 
-water, 440 
Taraxaci radix, 440 
Taraxacum, 440 
Tartar emetic, 85, 86 
Tartaric acid, 441 

Tartrate of antimony and potassium, 85 
86 
of iron and ammonium, 296 
and potassium, 296 



Tartrate of morphine, 366 

of potassium and sodium, 401 
Tea, beef, 550 
Terebene, 441 
Terebenum, 441 
Terebinthina, 449 

canadensis, 449 
Terminal infections, 19 
Terpine hydrate, 441 
Terpini hydras, 441 
Terpinol, 442 
Testicular juice, 259 
Thapsia, 442 
Thebaine, 357 
Theine, 134 
Theobromine, 303 

sodio-salicylate, 420 
Therapeutical considerations, general, 17 

nihilism, 17 
Therapeutics, definition of, 17 
Thiocol, 442 
Thiol, 443 
Thiolum liquidum, 443 

siccum, 443 
Thiosinamine, 443 
Thiosulphate of sodium, 422 
Thoroughwort, 250 
Thymol, 444 

iodide, 445 
Thymus glands, 445 
Thyreoidine, 448 
Thyroid gland, 259, 446 
Thyroideum siccum, 448 
Tinctura aconiti, 63 

aloes, 75 

et myrrhae, 75, 338 

arnicae, 99 

radicis, 99 

asafcetidae, 110 

belladonnas, 118 
folio rum, 118 

benzoini, 119 

composita, 119 

bryoniae, 132, 133 

buchu, 134 

calumbae, 140 

camphorae composita, 143, 365 

cannabis indicae, 147 

cantharidis, 148 

capsici, 151 

cardamomi, 156 
composita, 156 

catechu, 255 

chiratae, 161 

chloroformi et morphinae composita, 
187, 367 

cimicifugae, 189 

cinchonae, 197 

composita, 197, 419 

cinnamomi, 198 

colchici seminis, 212 

conii, 215 

convallariap, 216 

cubebae, 223 



860 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



Tinctura digitalis, 230 

ergotae ammoniata, 236 

ferri ehloridi, 295 

perchloridi, 295, 296 

galte, 254 

gambir composita, 255 

gelsemii, 257 

• gentianae composita, 257 

guaiaci, 262 

ammoniata, 262 

hamamelidis, 265 

humuli, 269 

hydrastis, 270 

hyoscyami, 275 

iodi, 286 

ipecacuanhae et opii, 365 

jaborandi, 391 

jalapse, 300 

kino, 302 

lobeliae, 312 

aetherea, 312 

lupuli, 269 

moschi, 337 

myrrhae, 338 

nucis vomicae, 354 

opii, 365 

ammoniata, 365 
camphorata, 364 
deodorata, 365 

phvsostigmatis, 386 

podophylli, 394 

pruni virginianae, 397 

quassiae, 398 

quininae, 195 

ammoniata, 195 

rhei, 401 

aromatica, 401 
composita, 401 
dulcis, 401 

sanguinariae, 411 

scillae, 425 

senegae, 417 

sennae composita, 418 

serpentariae, 418 

stramonii, 427 

strophanthi, 429 

sumbul, 434 

Valerianae, 453 

ammoniata, 453 

veratri, 456 

zingiberis, 258 
Tincture of cactus grandiflorus, 134 

of muriate of iron, 295 
Tinctures, 27 

changes in strength of, 52 
Toast, watered, 553 
Tonics, 43, 48 
Touchwood, 63 
Transfusion, 536 

abdominal, 539 

apparatus, 539 
Tribromomethane, 132 
Tribrom-phenol-bismuth, 458 
Trichloracetic acid, 448 



Trikresol, 448 
Trinitrin, 346 
Trinitrophenol, 386 
Trional (sulphonethylmethane), 449 
Trionalum, 449 
Triturates, 27 
Trituratio elaterini, 233 
Troches, 27 

Trochisci acidi benzoici, 120 
tannici, 439 

catechu, 255 

cretae, 139 

cubebae, 223 

eucalypti gummi, 249 

ferri reducti, 299 

gambir, 255 

glycyrrhizae et opii, 310 

guaiaci, 262 

ipecacuanhae, 292 

magnesiae, 313 

menthae piperitae, 375 

morphinae et ipecacuanhae, 366 

potassii chloratis, 168 

santonini, 412 

sodii santoninatis, 412 

sulphuris, 433 

zingiberis, 258 
Trochiscus acidi carbolici, 155 

bismuthi compositus, 120 

morphinae, 367 

et ipecacuanhae, 292, 367 
Tropic acid, 267 
Tropine, 267 
Trypsin, 372 
Tully's powder, 366 
Turkish bath, 505 

home modification of, 507 
Turpentine, 449 

liniment, 452 

ointment, 452 

stupe, 450, 494 
Turpeth mineral, 333 



U 



NGUENTS, 27 

Unguentum acidi carbolici, 155 

gallici, 254 

salicylici, 408 

tannici, 439 
aconitinae, 63 
antimonii tartarati, 89 
aquae rosae, 402 
atropinae, 119 
belladonnae, 118 
cantharidis, 149 
capsici, 151 
cetacei, 120 
chrysarobini, 188 
cocainae, 206 
conii, 215 
creosoti, 220 
eucalypti, 249 
gallae, 254 

cum opii, 254 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



861 



Unguentum glycerini plumbi subacetatis, 
261 
hamamelidis, 265 
hydrargyri, 330 

ammoniati; 324 
iodidi rubri, 327 
nitratis, 332 

dilutum, 332 
oleatis, 331 
oxidi flavi, 332 
rubri, 332 
subchloridi, 330 
iodi, 287 
iodoformi, 289 
petrolei, 378 
phenolis, 155 
picis liquidae, 440 
plumbi acetatis, 307 
carbonatis, 307 
iodidi, 307 
potassii iodidi, 282 
resinse, 398 
stramonii, 427 
sulphuris, 432 
terebinthinae, 451 
veratrinse, 454 
zinci oxidi, 368 
Unna's dressing, 368 
Uritone, 452 

Urotropin (hexamethylenamine), 452 
Ursin, 452 
Uva ursi, 452 
Uvse ursi folia, 452 



T7 ALE RATE of ammonium, 83, 453 
T of iron, 299, 453 

of quinine, 195, 453 

of zinc, 453 
Valerian, 452 
Valeriana, 452 
Valeriana rhizoma, 452 
Valerianic acid, 453 
Vallet's mass, 295 
Vapor acidi hydrocyanici, 273 

chlori, 170 

conii, 215 
Vaporization, 24 
Vaporizer, steam, 520 
Vaseline, 378 
Vasomotor depressants, 43, 49 

stimulants, 43, 49 
Vegetable astringents, 46 

cathartic pills, 213 

cathartics, 48 
Venesection, 540 
Veratri viridis rhizoma, 454 
Veratrina, 453 
Veratrine ointment, 454 
Veratroidine, 455 
Veratrum, 454 
Veronal, 456 
Vienna mixture, 186 

paste, 159, 457 



Vinegar, 58 

of ipecac, 292 

of lobelia, 312 

of opium, 365 

of sanguinaria, 411 

of squill, 426 
Vinegars, 26 
Vinum album, 70 

antimoniale, 89 

antimonii, 89 

colchici, 211 

seminis, 211 

ergotse, 236 

ferri am arum, 299 
citratis, 299 

ipecacuanha?, 292 

opii, 365 

picis, 440 

portense, 71 

quininse, 195 

rubrum, 70 

xericum, 71 
Virginia snake-root, 418 
Volatile oil of mustard, 336 



WAHOO, 249 
Warburg's tincture, 457 
Warming plaster, 149, 393 
Wash, black, 327 

yellow, 333 
Washed sulphur, 431 
Water of ammonia, 79 
stronger, 79 

of chloroform, 182, 187 
Watered toast, 553 
Waters, 25 
Weights and measures, 30 

tables of relative, 33 

apothecary, 30 

avoirdupois, 30 

metric, 31, 32 
Wet cups, 495 

pack, 509 
Whiskey, 70 
White ginger, 258 

lead, 307 

mustard, 337 

oak, 398 

petrolatum, 378 

precipitate, 324 
ointment, 324 

wine, 70 
Whytt's tincture, 197 
Wild cherry, 396 
Wine, 70 

of antimony, 89 

of citrate of iron, 299 

of colchicum, 212 

of colchicum-seed, 211 

of ergot, 236 

of ipecac, 292 

of iron, 299 
bitter, 299 



862 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



Wine measure, 30 

mulled, 553 

of opium, 365 

port, 71 

of quinine, 195 

red, 70 

of tar, 440 

whey, 70, 551 

white, 70 
Wines, 27 
Wintergreen, 255 
Witch-hazel, 265 
Wormseed, American, 160 



XANTHOPUCCIN, 269 
Xeroform, 458 

YELLOW cinchona, 177 
1 gentian, 257 

iodide of mercury, 332 

jasmine, 256 



Yellow oxide of mercury, 332 

prussiate of potassium, 217 

pyoktanin, 334 

sulphate of mercury, 333 

wash, 333 
Yeo's creosote inhaler, 219, 521 
Yolk of egg, glycerite of, 260 
Young's rule for dosage 28 



ZINCI acetas, 458 
carbonas. 458 

prsecipitatus, 458 
chloridum, 459, 466 
oxidum, 368 

venale, 368 
phenolsulphonas, 381 
sulphas, 459 
sulphocarbolas, 381 

as an antiseptic, 467 
valeras, 453 
Zingiber, 258 



INDEX OF DISEASES AND REMEDIES. 



ABORTION, 555 

Cascara sagrada, or compound liquorice 
powder, as a laxative for associated con- 
stipation; if these fail, rhubarb or castor 
oil, 555 

Creolin (2 per cent, solution), should be in- 
jected after removal of the membranes, 
or if fever should follow, 557 

Curette me nt, 557 

Diet and hygiene, 555 

Elaterium, jalap, scammony, strychnine, 
erigeron, cantharides, contraindicated, 
unless very necessary, 555 

Ergot and quinine, in small doses with 
perfect rest for one or two weeks, and 
antiseptic irrigation as an after-treat- 
ment, 556 

Iodine, applied to the inner surface of 
uterus, after removal of membranes, as 
a haemostatic and antiseptic, 557 

Opium or morphine, best agents to quiet 
uterus if abortion threatens, 556 

Podophyllin, senna, salines in active doses, 
and aloes, not to be used if they can be 
avoided, 555 

Quinine, useful in malarial poisoning, as a 
preventive; in other cases contraindi- 
cated, 557 

Saline purges contraindicated, except in 
plethoric women, 555 

Sponges should not be used as tampons, 556 

Tampons of absorbent cotton, dusted with 
iodoform, foUowed later by ergot, if 
abortion is inevitable, 556 

Venesection useful in plethoric women to 
prevent, 556 

Viburnum prunifolium, fluid extract, 
drachm £ to 1 (2.0-4.0), taken during 
pregnancy as a prophylactic, 556 

ABSCESS, 557 

Aconite or veratrum in full dose may abort, 

557 
Alcohol, given with milk, in cold abscess, 

558 
Belladonna ointment, locally applied to 

abort; or tincture, internally, if aconite 

is not at hand, 559 
Calx sulphurata, gr. T \ (0.006), every hour 

or two, useful to abort or cause absorp- 
tion, 558 
Carbolic acid, minims 5 to 10 (0.3-0.60) of 

2 per cent, solution, injected into gland 

threatening suppuration, 557 
Cod-liver oil with hypophosphites, quinine, 

and iron, useful in cold abscess, 558 



Hydrogen peroxide, 3 per cent, solution, 
to wash out cavity of tubercular or 
slow abscess, 274, 558 

Incision, if pus forms, followed by irrigation 
with phenol (1 :20) or bichloride solution 
(1:5000) and antiseptic dressing, 558 

Iodine, locally applied, may abort, 559 

Iodoform gauze, packed into cavity, or 
ethereal solution injected after aspira- 
tion, and antiseptic dressing, useful in 
tubercular abscess, 558 

Lead-water, applied on bread-crumb poul- 
tice or lint, in early stage, to abort, 557 

Nitrate of silver, gr. 20 to 40 (1.3-2.6) to 
the ounce (30.0), locally applied, may 
abort, 558 

Poultices to assist maturation, 557, 558 

Prescriptions for tonics, in cold abscess, 558 

ACIDITY. 

Ammonia, the most active remedy in gas- 
tric acidity, contraindicated if acute 
irritation exists, 79 

Bicarbonate of sodium, in form of efferves- 
cing powder, valuable in gastric acidity, 
421 

Bismuth a slow and feeble antacid, 120 

Carbonate of calcium, precipitated, best 
antacid in intestinal acidity, 137 

Cerium oxalate, used in some cases of gas- 
tric acidity instead of bismuth, 160 

Charcoal useful in some cases of "sour 
stomach," 155 

Lime-water, 140 

Liquor potassii hydroxidi useful both for 
gastric and urinary acidity, 310 

Magnesium a useful antacid, 314 

ACNE, 559 
Calx sulphurata, gr. ^ to £ (0.006-0.008), 

in pill, thrice daily, in pustular acne, 

141, 559 
Carbolic acid touched to pustules, after 

incision, 560 
Cod-liver oil, if scrofulosis exists, 559 
Fowler's solution often cures and prevents 

relapse, dose gtt. 1 to 3 (0.05-0.20), 

thrice daily, for a month or two, 559 
Green or Castile soap used in face-bath 

night and morning, followed by brisk 

rubbing; if irritation ensues, simple, 

cerate or emulsion of bitter almonds 

will relieve, 559 
Ichthyol, 20 to 100 parts of lard, well 

rubbed in, when induration is great, 

278, 560 

( 863 ) 



864 



INDEX OF DISEASES AND REMEDIES. 



Mercurial ointment, to relieve induration, 
several days intervening between its 
use and that of sulphur, 560 

Phosphorus especiallv useful in acne indu- 
rata, 384 

Resorcinol, gr. 10 to 20 to the ounce (0.60- 
1.3:30.0) of lard, when induration is 
great, 560 

Saline purges, followed by cascara sagrada 
or similar remedy, to regulate bowels, 
if dependent upon obstinate constipa- 
tion, 559 

Sulphur internally and as a wash or oint- 
ment for women with disordered men- 
struation, prescription for, 433, 559 

ADDISON'S DISEASE. 

Suprarenal gland, 436 

ADENITIS, 560 

Ichthyol, prescription for, 560 

Iodine ointment and lard, equal parts, ap- 
plied by inunction night and morning, 
or tincture, as a paint, stopping applica- 
tion on appearance of redness or fluc- 
tuation, 560 

Iron, svrup of the iodide, TT[10 to 40 (0.60- 
2.60) in children, 560 

Lancing preferable to allowing abscess to 
break, 560 

Poultice, when redness or fluctuation ap- 
pears, 560 

Removal of gland by dissection, if enlarge- 
ment is scrofulous. 560 

Tonics, to improve systemic condition, 560 

ALBUMINURIA. (See Bright 's Disease.) 

Cacodylate of iron in albuminuria of tuber- 
culosis, 295 

Gallic acid, if due to atony of kidneys, 254 

Juniper in albuminuria due to congestion, 
301 

Strontium lactate, if due to renal atony, 428 

ALCOHOLISM. (See Poisoning from 
Alcohol.) 

ALOPECIA, 561 

Chrysarobin, drachm \ to 1 (2.0-4.0) to 
lanolin, 1 ounce (30.0), 561 

Corrosive sublimate, gr. 2 (0.12) to rectified 
spirit 1 drachm (4.0) and oil of turpen- 
tine 7 drachms (28.0), 561 

Liquor epispasticus painted over bald spot 
after loose hairs have been depilated, 561 

Pilocarpine, locally applied, often stimu- 
lates new growth; too much causes small 
pustules around follicles; prescription 
for, 390 

AMBLYOPIA AND AMAUROSIS, 561 

Antipyrin, 563 
Bromide of potassium, 562 
Cauterization of nape of neck, 562 
Correction of optical errors, when arising 
from congenital trouble or non-use, 561 
Cups, wet and dry, 562 



Digitalis in toxic cases, 562 
Electricity, constant current, 562 
Emmenagogues, if due to menstrual dis- 
orders, 562 
Fly-blister to temple in, some cases, 562 
Iodide of potassium, 562 
Lactate of zinc, 563 
Mercury, when due to syphilis, 562 
Metallo-therapy, may be tried in hysterical 

cases, 562 
Nitrate of silver, 563 
Nitrite of amyl, inhalations, 562 
Nitroglycerin, 562 
Nux vomica in ascending doses in tobacco 

or alcoholic cases, 353 
Phosphorus, 563 
Pilocarpine, in ursemic, tobacco, or alcohol 

amaurosis, 389, 562 
Salicylates, 562 

Stretching the optic nerve, 563 
Strychnine, hypodermically, after irritation 

has subsided, 562 
Suspension, and injections of testicular 

juice, 563 
X-rays of no value after optic atrophy is 

established, 563 

AMENORRHEA, 563 

Aloes, as a specific, when dependent upon 
constipation, atony of sexual system, or 
anaemia, 74, 563 

Apiol, TT\ 2 to 8 (0.1-0.5), in capsule, thrice 
daily for a week before date of men- 
struation, 96, 564 

Arnica, 99 

Binoxide of manganese, gr. 1 to 3 (0.06- 
0.20), taken for two weeks before time 
of menstruation, 316, 563 

Cantharides, as a stimulant, if due to atony 
or depression, 148 

Cimicifuga, fluid extract, Til 30 (2.0), at 
the proper time for a flow, 189, 563 

Dewees's emmenagogue mixture, 564 

Eupatorium, in hot infusion, if due to cold, 
250 

GoodelPs prescription for, 563 

Griffith's' pills, largely used when depend- 
ent upon anaemia, 295 

Hot sitz-bath, for several nights before 
period; mustard added often increases 
its efficacy, 564 

Iron and myrrh, a standard remedy if due 
to atony or anaemia, 338, 563 

Oil of rue, TT\ 5 (0.3), in capsule, thrice 
daily, 564 

Potassium permanganate, useful, but infe- 
rior to binoxide of manganese, 377, 
564 

Salines inferior to aloes if due to constipa- 
tion, 563 

Savine, Vf[ 5 (0.3), in capsule, thrice daily, 
to stimulate uterus, 414, 564 

Tansy, TTl 5 (0.3), in capsule, thrice daily, 
or in form of tansy tea, 439, 564 

ANffiMIA, 564 

Aromatic mixture of iron, 294 
Arsenate of iron in anaemia of chronic 
diarrhoea, 294 



INDEX OF DISEASES AND REMEDIES. 



865 



Arsenic, not to exceed gr. -fa (0.006) daily, 
alone or combined with iron, valuable, 
567; very valuable in pernicious and 
malarial anaemia, 101 

Arsenite of copper, 219, 220, 568 

Beta-naphthol, when due to intestinal in- 
digestion, 567 

Bitters, simple or aromatic, in conjunction 
with iron, when stomach and intestines 
are atonic, 566 

Blaud's pill, 567 

Bromide of iron, gr. 5 to 20 (0.3-1.3), in 
syrup, useful when there is chorea, 
294 

Cacodylate of iron, when haemoglobin and 
corpuscles are lacking, 295 

Carbonate of iron, 295, 567 

Cerebral and spinal extracts useless in 
pernicious anaemia, 259 

Chloride of iron, useful because of its tonic 
properties, 296 

Dialyzed iron, 296 

Diet and hygiene, 568 

Hypophosphites and phosphate of lime, 
with cod-liver oil, iron, and quinine, 
when anaemia is due to childbearing and 
lactation, 139, 567 

Iodide of iron, syrup of, largely used in 
strumous and scrofulous anaemia, 297 

Iron, 293, 565 

Mercury, bichloride or calomel, especially 
valuable in syphilitic cases. Inunctions 
of mercurial ointment, once a day or 
every other day, of service in all forms 
of anaemia, 326, 567 

Ovarian extract in chlorotic type, 259 

Oxygen inhalations of value, 370 

Phenyl salicylate, when due to decomposi- 
tion-products, 410 

Quevenne's iron, 299, 567 

Quinine in malarial cases, and in tonic 
doses in all other anaemias, 567 

Reduced iron, with laxatives and mineral 
acids for their effects on intestines and 
liver, in uncomplicated cases, 299, 566 

Sodium cacodylate in anaemia of tubercu- 
losis, 421 

Sulphate of iron or some other astringent 
preparation in conjunction with mild 
purges, when tongue is broad, flabby, 
and white, 299, 567 

ANAL FISSURE, 568 

Belladonna ointment or suppository in 
spasm of the sphincter, due to fissure, 
116 

Castor oil, to relieve bowels if sulphur 
cannot be used, 569 

Flexible collodion, painted over spot, may 
relieve, 569 

Ichthyol, pure, applied locally, 569 

Iodoform suppositories, gr. 2 to 10 (0.12- 
0.60), relieve pain of defecation; bella- 
donna, gr. I (0.015), to be added when 
there is spasm of sphincter, 289, 568 

Phenol, 1 drop (0.05), applied to fissure to 
effect cure; in addition, when hemor- 
rhoids are present, a lotion of tannic 
acid, glycerin, and water, 568 



Potassium bromide, drachms H to the 
ounce (6.0:30.0) of glycerin, locally 
applied to fissure by means of a brush, 
highlv recommended, 569 

Sulphur, gr. 20 to 40 (1.3-2.6), combined 
with powdered cinnamon or aromatic 
powder, at night to render passages 
soft, 569 

ANEURISM 569 

Aconite, inferior to veratum as a cardiac 
sedative, 569 

Chloroform inhalation if dvspncea is great, 
570 

Digitalis, contraindicated, 569 

Electrolysis, 570 

Gelatin injected into the subcutaneous 
tissues, 570 

Iodide of potassium, in large doses, asso- 
ciated with restricted diet and rest in 
bed; more valuable in syphilitic than in 
other forms of the disease, 280, 569 

Morphine, gr. -J (0.008), combined with 
chloral or, better, with croton chloral, 
gr. 10 (0.60), in sleeplessness due to 
pain, 569 

Veratrum, m 4 to 8 (0.25-0.50), twice 
or thrice daily if heart is excitable and 
vascular tension high, 456, 569 

ANGINA PECTORIS, 570 

Aconite, useful between attacks, 572 
Alcohol, instead of nitrites, when there is 

vascular relaxation, 571 
Antipyrin, gr. 20 (1.3), valuable in some 

cases, 571 
Arsenic, in full doses long continued, and 

elimination of causes of nerve-storm, 571 
Cactus grandiflorus, in some cases, 134 
Digitalis, when heart is weak, 571 
Ether, in 1-drachm (4.0), doses in ice-water 

or capsule, to nervous females, often 

aborts, 571 
Hoffmann's anodvne, often the best remedv, 

266, 571 
Morphine, gr. J to \ (0.015-0.03), hypoder- 

mically, when nitrate of amyl fails to 

relieve, 571 
Nitrite of amyl, inhalation of a few drops 

from handkerchief during attack, 84, 570 
Nitrite of sodium or potassium, gr. 3 (0.20), 

thrice daily, useless unless arterial ten- 
sion is high and heart throbbing, 345, 

571 
Nitroglycerin, TTL 1 (0.05) of a 1 per cent. 

solution during attack, 346, 571 
Phosphorus, gr. ^-^ (0.0006), after meals, 

often of value, 571 
Prescription for use between attacks, 571 
Stomach-pump may be required when due 

to overloaded stomach, 572 
Tonics, combined with careful diet and 

hygiene necessary to a cure, 571 

ANOREXIA, 572 

Calomel, useful when following acute dis- 
ease; nitro-muriatic acid, however, gen- 
erally preferable, 329 



55 



866 



INDEX OF DISEASES AND REMEDIES. 



Capsicum, in convalescence, acts most 
favorably, 150 

Chimaphilia, in dropsical patients, as a 
tonic and diuretic, 160 

Eupatorium useful in, 250 

Gentian, 257 

Prescriptions for tonics, 572 

Quassia, especially valuable when follow- 
ing malarial fever, 397 

APOPLEXY, 572 

Belladonna, hypodermically, if respiration 
fail, 573 

Calomel, gr. \ (0.015) every four hours, if 
symptoms of meningitis arise, 573 

Croton oil, TT\ 1 (0.05), with sweet oil, V(\ 5 
(0.3), as a depletant cathartic, 572 

Diet, 573 

Elaterium, gr. £ (0.01), as a depletant 
cathartic, 573 

Ice to the head, 572 

Iodine of potassium, in large doses several 
days after attack, when clot has firmly 
formed, to promote absorption, 573 

Massage and electricity, applied to muscles 
to prevent atrophy; contraindicated if 
inflammation exist, 573 

Mercury, 573 

Mustard plaster to feet, or mustard foot- 
bath and ice to head, keeping head high 
and feet low, 572 

Opium and calomel, gr. \ (0.015) of each 
every four hours, if meningitis arise, 573 

Stimulants contraindicated, 574 

Strychnine, hypodermically, if respiration 
fail; is also useful to stimulate trophic 
centres in cord, 573 

Venesection, if patient is full-blooded, to 
prevent inflammation and further leak- 
age, 540, 572 

APPENDICITIS, 574 

Absolute rest necessary, 574 

Gastric lavage in nausea, vomiting, or gas- 
eous distention, 575 

Ice-bag or leeches, applied to appendicular 
region, 574 

Magnesium sulphate or citrate, 574 

Opium or morphine (after the bowels have 
moved), to relieve pain and act as an 
antiphlogistic, 574 

Rules for treating, 575 

Surgical treatment, 575 

ARTHRITIS. 

Bicarbonate of sodium, applied to part on 
lint, to allay pain, 421 

Lithium carbonate and citrate, prevent 
deposit in joints from rheumatoid ar- 
thritis, 311 

Mustard plaster, as a counterirritant, 337 

Veratrine ointment, 454 

ASCARIS LUMBRICOIDES. 

(See Worms.) 

ASCITES. (See Dropsy.) 
ASPHYXIA, 576 

Ammonia, injected intravenously into leg 
to stimulate heart and respiration, 78 



Artificial respiration, Sylvester's method, 

576 
Electricity, only to be used as a peripheral 

irritant to restore respiration, 579 
Laborde's lingual traction of great value, 

579 
Oxygen inhalations, 370 
Rules regarding position of patient, 578 

ASTHENOPIA, 579 

Cannabis indica, in retinal asthenopia, pre- 
scriptions for, 146 
Eserine or pilocarpine, weak solution, as a 

stimulant to ciliary muscles, 580 
Glasses, combined with prisms if necessary, 

to correct optical defects, 580 
Hot compresses, 580 
Massage, rest, salt baths, strychnine, and 

iron, if due to neurasthenia, 580 
Strychnine or tincture of nux vomica in 

large doses, to stimulate ciliary muscles, 

580 

ASTHMA, 580 
Aconite, in early stages, 62 
Amyl nitrite, 3 to 6 minims (0.20-0.4) on 

handkerchief, inhaled with care, relieves 

spasm, 84, 581, .582 
Arsenic, internally or smoked in cigarettes, 

best remedy when mucous membrane is 

at fault, 103, 583 
Belladonna, combined with morphine, very 

useful, 116, 581 
Bromide of potassium or sodium, gr. 30 

(2.0), half an hour before retiring, 583 
Bronchitis-tent, 583 
Chloral, rarely useful ; if pushed, dangerous, 

165 
Chloroform, inhaled, relaxes spasm; also 

useful in form of liniment applied to 

chest, to abort, 183 
Cocaine, applied to nasal cavities, if due 

to nasal disorders, 583 
Coffee, a cup of strong black, during par- 
oxysms, 136, 582 
Compressed and rarefied air, 583 
Diet and hygiene, 583 
Ethyl iodide, to increase secretions and 

prevent thickening, 247 
Euphorbia pilulifera, i to 1 drachm (2.0- 

4.0) of the fluid extract, 250, 582 
Gelsemium, 257 
Grindelia, fluid extract of, TT1 10 to 30 

(0.60-2.0), or leaves soaked in nitre 

smoked as cigarettes, or fumes of burn- 
ing leaves inhaled, exceedingly useful, 

261, 583 
Iodide of potassium, useful in bronchial, 

harmful in gastric, type, 281, 583 
Lobelia, tincture, TT\ 10 (0.60) every four 

hours, if attack threaten; in emetic dose 

if heart be strong, when spasm is present, 

312, 581, 583 
Morphine, hypodermically, gr. \ to \ (0.01- 

0.015), alone or combined with atropine, 

581 
Nitrate of potassium alone or combined 

with belladonna, in form of cigarettes 

or inhalation of fumes, often relieves, 

340, 581, 582 



INDEX OF DISEASES AND REMEDIES. 



867 



Nitroglycerin, serviceable if bronchial 
mucous membranes are engorged, 347, 
582 

Oil of amber, 77 

Oxygen inhalations when cyanosis is 
extreme, 583 

Physostigma, in bronchial asthma, to aid 
in expelling mucus, 386 

Sandalwood oil, useful in catarrhal cases, 
411 

Tobacco-smoking often efficacious in pa- 
tients not accustomed to it, 582, 583 

Zinc oxide, prescription for, 369 

ATONY. 

Arsenic, in gastric and intestinal atony, 

101, 103 
Calumba, valuable in gastro-intestinal 

atony, following fevers, 140 
Capsicum, one of the best remedies in gas- 
tric atonv due to debility and alcoholism, 

69, 149 
Cardamom, with bitter tonics and mineral 

acid, in gastro-intestinal atony, 156 
Chimaphilia, useful as a stimulating diuretic 

in atonic renal conditions, 160 
Hydrastis, indicated in atony of mucous 

membranes, 269 
Leptandra, in duodenal atony, 309 
Mustard, in gastric atony of drunkards, 338 
Pepper, in atony of genito-urinary mucous 

membranes, 374 
Physostigma, in intestinal and vesical 

atony, 386 
Strychnine, in intestinal atony, 353, 354 

AURAL VERTIGO. 

Pilocarpine, 390 

BALANITIS AND BALANOPOSTHITIS, 

678 

Astringent solutions, to cleanse parts, zinc 
chloride (gr. 4 to the ounce [0.25-30.0]), 
boric acid (1 percent.), phenol (1.5 per 
cent.) ; silver nitrate (gr. 1 to the ounce 
[0.06:30.0]) especially valuable, 678 

Lead-water, dilute, as a wet dressing, pre- 
ceded by astringent washes, in phimo- 
sis; if inflammation increases, circum- 
cise, 678 

Silver-nitrate stick, touched to ulcerations, 
678 

Tannin or zinc oxide, as a dusting-powder, 
after retracting prepuce and cleansing 
over absorbent cotton, 678 

BALDNESS. (See Alopecia.) 

BED-SORES, 584 

Aloes, glycerole of, as a local application, 

74 
Alum, with spirit of camphor and white 

of egg, locally applied, to prevent, 584 
Gambir, with lead subacetate, locally 

applied, to harden skin, 584 
Glycerin application daily, after washing 

and rubbing part, to prevent, 260 
Incision, followed by irrigation, if sores 

tend to burrow, 585 



Iron, tincture of chloride, W\ 20 (1.3) every 
four hours, as a tonic, 585 

Nitrate of silver (gr. 20 to the ounce [1.3: 
30.0]), painted over threatening part, to 
abort. If ulcers form and are sluggish, 
same solution may be used, 343, 584, 585 

Salt and whiskey, rubbed over skin to 
harden it (drachms 2 to the pint [8.0: 
480.0]), 584 

Soap plaster, applied to sore after washing 
with bichloride solution (1 :5000) and 
dusting with iodoform, 419, 584 

Supportive measures and increased amount 
of food, if sloughs are large, 585 

Zinc ointment, on squares of lint, some- 
times used in lieu of soap plaster, 584 

BILIOUSNESS, 585 

Aconite, antagonizes the poisoning alka- 
loids which cause slow pulse, high arte- 
rial tension, etc, 588 

Ammonium chloride, gr. 5 (0.3) thrice 
daily, if associated with catarrh, 588 

Bromides and chloral, if nervousness and 
irritation are present, 588 

Calomel, gr. -£- (0.01) in powder every fifteen 
minutes until six are taken, followed in 
four hours by a saline, if stools be light, 
323, 329, 587 

Chirata, extract of, gr. 5 (0.30), in hepatic 
torpor, prescription for, 587 

Diet, 587 

Euonymus, extract of, gr. 3 (0.20), 587 

Horseback riding combined with gymnastic 
movements especially valuable, 587 

Ipecac, powdered, gr. 30 to 60 (2.0-4.0), or 
apomorphine, gr.'-^ (0.004) hypodermic- 
ally, may relieve in first stage, 586 

Leptandra, where liver is torpid, 309 

Mustard plaster or cup to nape of neck, if 
face flushed ; foot-bath also of service, 588 

Nitro-muriatic acid, TT1 3 (0.20), thrice 
daily in water, of great service, 348, 567 

Podophyllin, gr. £ (0.01), if stools be dark, 
587 

Protiodide of mercury, gr. *$ to ^ (0.001- 
0.0015), in trituration, thrice daily, if 
due to catarrh, 588 

Salines, if attack is sudden, to sweep out 
poisonous matter, 587 

Salol (phenyl salicylate) or salophen, in 10 
gr. (0.60) doses, useful as an intestinal 
antiseptic, 588 

Stillingia, fluid extract of, dose, 20 drops 
(1.3), 585 

BLEPHARITIS, 588 

Boric-acid lotion when there is accompany- 
ing conjunctivitis, 588 

Chloral, 5 per cent, solution, to remove 
scabs and crusts, 588 

Creolin, 1 to 2 per cent, solution, use as 
a wash, 221 

Methyl blue, 333 

Ointments, dilute citrine, Pagenstecher's 
ointment (yellow oxide of mercury, 1 gr. 
[0.06]), vaseline, 1 drachm (4.0), pyrogallic 
acid, milk of sulphur (3 percent.), locally 
applied after removal of crusts, 588 



868 



INDEX OF DISEASES AND REMEDIES. 



Silver nitrate, touched to crater-like ab- 
scesses, gives good results, 588 

Sodium bicarbonate or biborate solution, 
gr. 8 to ounce (0.5:30.0), to remove 
scabs and crusts, 588 

BOILS, 589 

Belladonna, locally applied to relieve pain 
and inflammation, 589 

Calcium sulphurate hastens pointing and 
prevents formation of new ones; useless 
in boils of diabetes, 141, 589 

Camphorated alcohol, applied over boils in 
formative stage, then wiped dry, fol- 
lowed by camphorated oil to abort, 143, 
589 

Chloride of calcium, added to poultice, 
hastens maturation, 138 

Collodion painted over inflamed spot, to 
abort; 212; if pus form, it may be ab- 
sorbed, if not, evacuate by incision, 
589 

Egg-shells baked and eaten, for successive 
crops, 141 

Opium, locally applied to relieve pain and 
inflammation, 589 

Phenol, 5 per cent, strength, injected into 
apex of boil when formation is assured, 
to abort, 154, 589 

Phosphorus, 384 

Poultices, containing sweet oil and lauda- 
num, to assist maturation, 589 

Prescription for ointment, 589 

Silver nitrate (gr. 20 to the ounce [1.3: 
30.0]), painted over part, may abort, 
343, 589 

BONE DISEASE. 

Iodide of iron, syrup of, if anaemia exist, 
284 

Iodine ointment, diluted one-half, or tinc- 
ture, locally applied, 284 

BREASTS (INFLAMED), 590 

Aconite of veratrum, to depress circulation, 

590 
Belladonna, internally or as an ointment, 

before and after inflammation, with cold 

compresses to breast, 116, 118, 590 
Breast-pump, if milk continues to form, 

590 
Incise as soon as pus forms, 590 
Pressure bandage with ice-bag, 590 
Purges, mild saline, 590 

BREATH, FETID. 

Camphor, as a mouth- wash, 142 

BROMIDROSIS. 

Belladonna, 115 

Borax of great value, 123 

Carbonate of calcium, precipitated, a useful 

application, 137 
Formaldehyde useful, 253 
Lead plaster and linseed oil, equal parts, 

applied every third day, 308 
Salicylic acid, used as a dusting-powder, 

prescription for, 407 



BRONCHITIS, 590 

Aconite, alone or combined with sweet 
spirit of nitre, in initial stage, 62, 591 

Amber, oil of, and olive oil (1 :3), applied 
to back and front of chest, in infantile 
bronchitis, 77 

Ammoniac, useful in old forms devoid of 
inflammation, 79 

Ammonium carbonate, alone or with the 
chloride, especially useful in children; 
gr. 2 to 10 (0.12-0.60) in svrup of acacia, 
81 

Ammonium chloride, in second stage to 
stimulate bronchial tubes, prescription 
for, 82, 518, 593 

Apomorphine, 98 

Asafoetida, as a stimulating expectorant, 
110 

Belladonna, to check excessive secretion 
and stimulate respiration, 595 

Benzoic acid, 119 

Bronchitis tent, 510, 592 

Caffeine, or strong coffee, to stimulate 
respiration if suffocation threatens, 595 

Camphor, in old or atonic cases, 142; 
liniment rubbed on chest, 591 

Cimicifuga in chronic bronchitis, 189 

Codeine, recommended when cough is ex- 
cessive, 207, 594 

Creosote, recommended in chronic bron- 
chitis, 218 

Croton oil and sweet oil (half and half), 
sometimes applied to chest, 222 

Cubebs or copaiba, as expectorants, liable 
to derange stomach, 216, 222, 594 

Digitalis, if heart be feeble, 595 

Dover's powder, gr. 5 to 10 (0.30-0.60), 
with a hot drink, useful in early stage, 
591 

Dry cups, if secretion is excessive, 595 

Ethyl iodide, 5 to 10 minims (0.3-0.60), 
inhaled from a handkerchief every few 
hours in the later stages to loosen secre- 
tions, 247, 594 

Eucalyptus oil, valuable in later stages; 
dose, gtt. 1 to 5 (0.05-0.30), in capsule, 
every three hours, 249, 594 

Euphorbia pilulifera, ^ to 1 drachm (2.0- 
4.0) of fluid extract, in chronic bron- 
chitis, 250 

Flaxseed tea, a useful demulcent, 252 

Gallic acid for profuse expectoration, 254 

Grindelia, very useful in later stages, 261 

Guaiacol vapor inhalations very valuable, 
263 

Hot foot-bath, with drinks of hot lemon- 
ade, in early stages, 591 

Hypnal for cough, 277 

Inhalations of steam from boiling water, 
to relieve bronchial soreness when 
counterirritation fails, 518, 520 

Iodide of potassium, often useful when 
ammonium salts fail, contraindicated if 
secretion is excessive, 281 

Iodine externally, 285 

Iodoform, to lessen cough and fetid dis- 
charge, 289 

Ipecac, to unload stomach, 291 ; as a seda- 
tive expectorant, 291 

Mustard plasters, 591, 595 



INDEX OF DISEASES AND REMEDIES. 



869 



Myrrh with expectorant mixtures, useful 
in later stages, 338 

Oro-nasal respirator with terebene, iodide 
of ethyl, and chloroform, 594 

Oxygen inhalations, when dyspnoea is 
great, 370, 595 

Potassium citrate with ipecac, to aid forma- 
tion of secretion, prescriptions, 395, 591 

Potassium cyanide for excessive cough, 223 

Resin, inhalation of fumes, 398 

Sandalwood oil, in later stages, dose 5 to 
10 minims, 411, 594 

Sanguinaria, 411 

Senega, a stimulating expectorant in sub- 
acute and chronic stages, 416 

Squill, inferior to other drugs as an expec- 
torant, 425 

Steam inhalations, 520, 591 

Strychnine, to stimulate respiration, if 
suffocation threatens, 595 

Tar, 440 

Tartar emetic, as an expectorant, gr. ^ 
(0.001) hourly, or 1 drachm (4.0) of solu- 
tion (gr. i (0".03) to 4 ounces [120 c.c.]), 
or as an emetic in sthenic cases, 88 

Terebene, if ammonium chloride fails; 
dose, 5 to 10 minims (0.3-0.60), in cap- 
sule or emulsion; must be stopped if 
kidneys or stomach are irritated; or used 
in an inhaler with equal parts of iodide 
of ethyl and chloroform, 441, 594 

Terpine hydrate or terpinol useful, 442, 954 

Thiocol in chronic bronchitis, 443 

Turpentine, inhalations or applied to chest, 
for children diluted one-half with sweet 
oil, 451 

Turpentine stupes, as counterirritants, 595 

Water, hot and cold dashes, if death is 
imminent from suffocation, 595 

BRONCHOCELE. 

Ointment of biniodide of mercury, useful 

in, 327 
Potassium iodide internally, and tincture 

of iodine externally, 281 
Thymus gland in, 446 

BRONCHORRH(EA. 

Alum, solution, gr. 20 to the ounce (1.3: 

30 0), applied in fine spray, 76 
Gallic acid, 254 

BRUISES. 

Alcohol, as a lotion, very useful, 67 

Arnica, 99 

Liquor plumbi subacetatis, locally applied; 
strength 1 to 4 ounces to the pint (30.0- 
120.0:480.0); contraindicated, if skin 
is broken; also useful as lead-water 
and laudanum (water 16, lead-water 4, 
laudanum 1), 307, 363 

Warming plaster, 393 

BUBO. 

Incision, at first sign of suppuration, fol- 
lowed by washing with either bichloride 
solution' (1 : 1000), hydrogen peroxide 
(£ strength), or zinc chloride (gr. 40 to 
the ounce [2.6:30.0]), 599 



Iodine, painted around spot, with compress 
and spica bandage, or hot bag over 
swelling, 599 

Phenol, solution (gr. 8 to the ounce 
[0.5:30.0]), 10-minim injections, pre- 
ceded by ether spray, 154 

BURNS AND SCALDS, 596 

Adrenalin chloride, drachm 1 (4.0) of a 
1 :1000 solution, in a pint of normal salt 
solution intravenouslv as a stimulant, 
596 

Anaesthesia, chloroform in, 597 

Bath in the treatment of, 596 * 

Boric-acid solution, a useful dressing, 123, 
596 

Calcium carbonate, precipitated, as a dress- 
ing, 137 

Cantharides, tincture of (1:40), locally 
applied on lint if burn is not diffuse, 
597 

Carbolized sweet oil, cosmoline, or simple 
cerate, useful application to counter- 
irritation burns, 154, 596 

Carron oil in, 141 

Chloretone in 10 per cent, ointment, 169; 
as a dusting powder, 596 

Cold cream, as a dressing, 402 

Digitalis, in shock, if circulation fails to 
respond to less powerful stimulants, 
596 

Glutol, as a dressing, 253 

Hypodermoclysis useful, 513 

Ichthyol ointment, 278 

Lead carbonate, as an ointment, or, with 
linseed or other oils, as a dressing, 307 

Lime-water and linseed oil, equal parts, the 
best dressing, 252; carbolic acid is of 
service, added in proportion of 1 to 20, 
596 

Morphine and atropine, gr. \ to h (0.015- 
0.03) of former to gr. ^ (0.0006) of 
latter, to allay pain, 596 

Nargol ointment, 5 to 10 per cent., 340 

Orthoform, as an antiseptic and anaesthetic, 
367 

Picric acid the best dressing, 387, 596 

Potassium citrate with sweet spirit of 
nitre, if urine is high-colored, 597 

Poultice, applied to counterirritation blis- 
ter, relieves pain; when blister forms, 
puncture if large, allow to break if 
small, and dress with absorbent cotton, 
494 

Salicylic acid, prescription for, 407 

Sodium carbonate solution often relieves 
pain, 597 

Stimulants, if shock is severe, 596 

Zinc oxide, 368 

CANCER (GASTRIC). 

Arsenic, small doses often repeated, to 
relieve vomiting and pain in gastric 
cancer, 103 

Condurango, in the dose of 1 drachm (4.0) 
of the fluid extract, 214 

Chloretone, to relieve pain, 168 

Hydrochloric acid, 271 

Lavage in, 524 



870 



INDEX OF DISEASES AND REMEDIES. 



CANCRUM ORIS. 

Arsenic internally, 103 

Boric acid, as a mouth-wash, 123 

CARBUNCLE. 

Phenol solution (gr. 8 to the ounce 
[0.5:30.0]), hypodermic injections, to 
abort, 154 

Phosphorus, 384 

CARIES. 

Lime salts, especially valuable in dental 
caries of nursing women, 139 

CATARRH OF AIR-PASSAGES. (See 

Nasal Catarrh.) 

Alum solution (gr. 20 to the ounce [ 1 .3 : 

30.0]), applied in fine spray, 76 
Arsenic, internally, 103 
Camphor, of service in old and atonic cases, 

142 
Ethyl iodide, by inhalation in subacute or 

chronic catarrh, 247 
Sozoiodol, applied locally in 5 per cent. 

solution, 424 

CATARRH OF BLADDER. 

Ammonium benzoate, to render urine acid, 

80 
Juniper, a valuable stimulant in chronic 

cases, 301 

CATARRH OF UTERUS. 

Hydrastis, 269 

Sozoiodol, in powder, applied by tampon, 
in catarrh of cervix uteri, 424 

CEREBRAL DISEASES. 

Blisters, to nape of neck in cerebritis, 492 
Croton oil, in cerebral congestion, 222 
Elaterium, in cerebral congestion, 233 
Phosphorus, often of service in cerebral 

softening, 384 
Veratrum, of greatest value in cerebritis 

during stage of hypersemia, after that 

period harmful, 456 

CHANCRE. 

Nitric acid, used as a caustic, surrounding 
tissues being protected by oil, 344 

CHANCROID, 597 

Acetanilid, used in a dry powder, 57 
Actual cautery, the most destructive 

caustic, 598, 599 
Benzoate of bismuth, 121 
Bismuth and zinc oxide, or calomel and 

bismuth, are substitutes for iodoform, 

598 
Cocaine, 20 per cent, solution, to relieve 

pain of cauterization, 598 
Hot sitz-bath or general warm bath, 599 
Iodoform, the best dusting-powder _ after 

cauterizing, also useful as a palliative 

treatment, preceded by nitric-acid wash 

(3j to water Oj [4.0:480.0]), in erosive 

chancroid, 598 



Iodol or aristol, as a substitute for iodo- 
form, 598 

Nitric acid, a good caustic, surrounding 
tissues being protected by oil, 344, 598 

Phenol, as a wet dressing (gr. 5 to water 
oz. 1 [0.30:30.0]), 590 

Salicylic acid in powder or ointment, 407 

Sulphuric acid with charcoal, a good 
caustic and after-dressing, 598 

Tannin, combined with dusting-powder 
(1 :4), if discharge is profuse, 599 

CHAPPING. 

Calcium carbonate, precipitated, as a local 
protective in intertrigo of infants, 137 

Camphor, added to precipitated calcium 
carbonate, useful in intertrigo, 143 

Carbonate of zinc, in infantile forms, pre- 
scription for, 458 

Cold cream, a useful application, 402 

Light magnesia, as a dusting-powder in 
intertrigo, 313 

Lycopodium, as a dusting-powder, 313 

Starch, as a dusting-powder in intertrigo, 
426 

Zinc oxide, in powder form, useful in 
intertrigo, 369 

CHILBLAINS. 

Alum, as a wash, 76 

Capsicum, tincture, painted over parts or 

applied as a paper, prescription for, 150 
Ceratum resinae, 398 
Ichthyol ointment, 278 
Iodine ointment and lard, equal parts, 

give great relief, 285 

CHLOROSIS. (See Anaemia.) 

CHOLERA (ASIATIC), 600 

Camphor, in the form of camphorated wine 
of the greatest service in controlling 
cramps, 600 

Enemata of warm salt solution (5j) to Oj 
[4.0 to 480.0]), highly recommended by 
Italian observers, 601 

Enteroclysis, associated with hot baths, 
very valuable, 499, 601 

Ether, subcutaneously, as a diffusible stim- 
ulant, 601 

Hypodermoclysis, very useful, 513, 602 

Opium, 600 

Phenyl salicylate and salophen, 410, 601 

Purgatives, contraindicated unless bad 
food has been taken, 600 

Quarantine and strict hygiene, as pro- 
phylactics, 600 

Sulphuric acid with camphor, to control 
diarrhoea, 434, 600 

Tannic acid, by enemata (3j" vn j to Oj 
[4.0-30.0 :480'.0]), 602 

CHOLERA INFANTUM, 602 

Arsenic, to check vomiting, prescription 

for, 604 
Beef-juice, as a food, especially valuable, 

604 



INDEX OF DISEASES AND REMEDIES. 



871 



Brandy, if vomiting is active and collapse 
threatens, a few drops to drachm (4.0) 
of nourishment, 603 

Castor oil, with paregoric, to empty bowels 
and allay irritation, 603 

Cold drinks, cracked ice, and antipyretics, 
if rectal temperature is above normal, 
602 

Diet, 603 

Enteroctysis, very valuable, 605 

Hot drinks, applications, and baths if 
rectal temperature is subnormal, temper- 
ature being watched, 602 

Iodoform and oil injections to relieve tenes- 
mus, 289 

Irrigation of bowels, 605 

Laudanum, ffl 10 (0.60), and starch-water, 
oz. 2 (60.0), by enema, and calomel, gr. 
^ (0.005), or gray powder, gr. \ (0.01), 
by mouth, to control vomiting and purg- 
ing, if severe, 604 

Mustard or spice plaster, over belly, always 
useful, 605 

Podophyllin, if stools are of peculiar pasty- 
white color, 603 

Prescriptions for, 604, 605 

CHOLERA MORBUS, 605 

Camphor, 142 

Castor oil, with laudanum, to sweep out 
intestines, before diarrhoea mixture is 
used, 605 

Ipecac, gr. 3 (0.20) every two hours, often 
of service, 291 

Morphine and atropine, if pain is severe, 
606 

Mustard or capsicum plaster, over abdo- 
men, 605 

Prescription for, 605 

Salol (phenyl salicylate), prescription for, 
410 

CHORDEE, 674 

Aconite, often relieves, 62 

Belladonna internally, and ointment ap- 
plied to under surface of penis, 116 

Bromide of potassium, drachm 1 (4.0), with 
chloral, gr. x (0.6), at bedtime, repeated 
during night if necessary, 674 

Camphor with bromides, very useful in 
some cases, 142 

Cantharides, XT[ 1 (0.05), thrice daily, 148 

Hot sitz-bath and steeping penis in hot 
water before retiring, relieves, 504 

Lupulin, gr. 30 (2.0), 674 

Morphine, gr. ^ (0.015), with atropine, gr. 
g 1 ^ (0.001), hypodermically near peri- 
neum, to relieve, 674 

Opium or belladonna suppositories, to re- 
lieve, 674 

CHOREA, 606 

Arsenic, in ascending doses ; discontinued if 
symptoms of poisoning ensue, 101, 606 

Bromides with chloral, when there is in- 
somnia, prescription for, 607 

Chloral, 160 

Chloroform inhalations when excessive, 179 

Cimicifuga alone, or with arsenic, very 
useful, 189, 606 



Hot pack, at bedtime, if muscular jerkings 
are severe, 509, 606 

Monobromated camphor, 144 

Nitroglycerin, 346 

Quinine in full doses, 194 

Salicylates or iodides of value, if associated 
with rheumatism, 606 

Silver nitrate, occasionally used, not re- 
liable, 342 

CINCHONISM. 

Potassium bromide, as a preventive, 129 

CIRRHOSIS OF LIVER. (See Hepatic 
Cirrhosis.) 

COLDS. (See Coryza.) 

COLIC. 

Asafcetida, useful in children, 110 

Chloral and bromide, when severe in chil- 
dren; prescription for, 164 

Ether internally, very useful, 243 

Hoffmann's anodyne, 266 

Hyoscyamus, 275 

Matricaria, infusion, to prevent, in teeth- 
ing children, 316 

Mustard plaster, \ to % strength, if skin is 
tender, 337 

Peppermint in infantile colic, 374 

Rue, as a carminative, 402 

COLIC (HEPATIC), 607 

Belladonna, in full doses, to relax spasm, 
116 

Benzoate of sodium, 609 

Calomel, if liver be very torpid, 609 

Chloroform or ether inhalations, to relieve 
pain during spasm, 182, 609 

Diet, 609 

Hot applications over liver, as a relaxant, 
607, 609 

Horseback riding, 608 

Morphine, gr. \ to \ (0.015-0.03), with 
atropine, gr. r J ff (0.0006), hypodermic- 
ally, to relieve pain ? 607 

Olive oil or cotton-seed oil, 1^ pints (720.0), 
during attack; ether, drachm 1 (4.0), 
may be added with advantage, 607 

Opium with belladonna, to relieve pain 
and spasm, 361 

Salicylate of sodium, 609 

Turpentine, useful in, 607, 609 

COLIC (LEAD). 

Alum with morphine to allay pain, 76 

COLIC (RENAL). 

Belladonna, in full dose, 116 

Chloroform, a few inhalations often relieve, 

182 
Opium with belladonna relieves spasm and 

pain, 361 

COLLAPSE. 

Belladonna, as a vasomotor stimulant, 115, 

117 
Digitalis, 229 



872 



INDEX OF DISEASES ASD REMEDIES. 



Ether, by mouth, inhalation, or hypoder- 
mically. of great service. 2-43 

CONDYLOMATA. 

Calomel, as a dusting-powder, often re- 
moves, 330 

CONGESTION. 

Croton oil, as a revulsive in cerebral con- 
gestion, 222 

Digitalis, relieves stasis of congested lung 
in tvphoid state, and congestion of the 
kidneys, 229 

Elaterium, in cerebral congestion, 233 

Ergot of service, especiallv with digitalis. 
235 

Glycerin, on cotton tampon, as a depletant 
in uterine congestion, 260 

Jalap, useful in plethora with cerebral con- 
gestion, 300 

Juniper, often relieves congested kidnevs, 
301 

Mustard, to nape of neck in cerebral con- 
gestion, 337 

CONJUNCTIVA (BURNS OF), 611 

Atropine incorporated with liquid vaseline 
instilled into eye. to prevent iritis, 611 

Cod-liver oil instilled into eye after re- 
moval of foreign matter. 611 

Gold-beaters' skin inserted between licls 
and eyeball, or breaking up granula- 
tions, prevents corneal inflammation. 611 

Neutralization of foreign matter, if acid 
or alkaline, 611 

CONJUNCTIVA rCHEMOSIS OF , 614 

Astringent washes, especially alum. 614 
Xicking swollen tissue with scissors, 614 
Warm, moist compresses, 614 

CONJUNCTIVA (HEMORRHAGE BE- 
NEATH;, 614 

Boric-acid or cocaine wash, when conjunc- 
tival irritation exists. 615 . 

Massage of globe through closed lids, to 
aid absorption of blood, 615 

CONJUNCTIVITIS CHRONIC , 612 

Acetate of zinc. gr. 1 to 2 (,0.06-0.12), to the 
ounce (30.0), 45S 

Boric acid, wash (gr. 10 to the ounce [0.60 : 
30.0]), cocaine, gr. 2 (0.12), may be added 
if there is no corneal ulcer ; for this con- 
dition salt. gr. 4 to the ounce (0.25:30.0 . 
may be substituted, 612 

Copper crystal, or a solution Cgr. 1 to 3 to 
the ounce [0.06-0.20:30.0]. applied to 
diseased spot, if subacute, 218 

Correction of any refractive error. 612 

Lapis chvinus, 612 

Tannin and glvcerin (gr. 10 to the ounce 
[0.60:30.0]), as an application. 612 

Yellow oxide or sulphate of mercury salve, 
or alum crvstal. useful application. 333. 
612 

Zinc oxide, in powder, or the sulphate in 
the form of a wash. 369. 613 



CONJUNCTIVITIS (DIPHTHERITIC , 

614 
Antitoxin injections the best treatment, 614 
Atropine instilled, 614 
Boric-acid or bichloride solution, frequently 

applied in early stages, 614 
Hot compresses, 614 

CONJUNCTIVITIS FOLLICULAR., 613 

Alum, crystal, applied locally if due to 

atropine instillations, 613 
Astringent and antiseptic lotions, 613 
Calomel, as a dusting-powder, alone or 

with bismuth, aristol, or iodoform, 613 
Copper sulphate, as an ointment (gr. % to 

the drachm [0.03 :4.0]), 218, 613 

CONJUNCTIVITIS GRANULAR), 613 

Adrenalin locally, 436 

Atropine, instillations, in acute forms, 613 

Boric acid or salicylic acid, solution, as a 
wash in acute forms. 613 

Boroglyceride (20 to 50 per cent.), applied 
to chronic granulations, 613 

Copper sulphate, crystal, applied to chronic 
granulations, 218", 613 

Corrosive sublimate solution (1 :300 or 1 : 
500), applied every second day in 
chronic forms, preceded by cocaine, 
eyes also being irrigated thrice daily 
with sublimate solution (1 :7000), 613 

Crushing granulations, often satisfactory, 
614 

Excision of granulations when isolated, 614 

Glycerole of tannin, applied to chronic 
granulations, 613 

Grattage. 614 

Jequirity infusion (3 per cent.) painted on 
inner side of eyelids, of use. 301. 614 

Leeches to temple, to reduce inflammation 
in acute stage, 613 

Liquor potassii hydroxidi, beta-naphthol, 
iodoform, aristol in powder or salve, yel- 
low-oxide ointment, calomel, or hydras- 
tin may be tried. 614 

Scarification, not advisable. 614 

Silver nitrate, stick or solution (gr. 10 to 
the ounce [0.60:30.0]). applied daily, if 
there is discharge : neutralize excess with 
^ salt solution. 343. 613 

Yellow oxide of mercury ointment with 
lard, equal parts, in chronic types, 332 

CONJUNCTIVITIS fLACRYMAL). 

Treatment same as for chronic type. 

CONJUNCTIVITIS MUCOPURULENT). 

Treatment same as for purulent type. 

CONJUNCTIVITIS fPURULENT;, 611 

Atropine, if corneal ulcer appears, 611 

Bichloride of mercury (1 -.8000), formalde- 
hyde (1:3000; . or boric acid (saturated 
solution), as a wash, used hourly, 611 

Boroglycerin. 124 

Creolin solution. 1 per cent.. 221 

Hot compress, in lieu of cold, if vitality of 
cornea is threatened. 611 



INDEX OF DISEASES AND REMEDIES. 



873 



Iced compress in early stage, to reduce 
inflammation, 611 

Leeching, useful if inflammation is high, 
contraindicated in infants, 612 

Permanganate of potassium, aqua chlorini, 
argentamin, protargol, sulphocarbolic 
acid solution, alum sulphate, zinc sul- 
phate, creolin (1 per cent.), or iodoform 
ointment may be tried, 612 

Silver nitrate, stick or solution (gr. 10 to 
the ounce [0.60:30.0]), touched to lids 
after they have been cleansed of pus, 
excess neutralized with salt solution ; 
2 per cent, solution dropped in newborn 
infant's eyes to prevent, 611 

Sozoidol (2:30), 424 

CONJUNCTIVITIS (SIMPLE), 610 

Alum crystal applied when it tends to be- 
come chronic, 610 

Argyrol, 5 to 20 per cent, solution in place 
of silver nitrate, 610 

Atropine usually unnecessary unless cor- 
neal ulcer is present, 610 

Boric acid, lotion (gr. 10 to the ounce 
[0.60:30.0]), 610 

Compresses of ice to allay inflammation, 
610 

Mercury, bichloride solution (1 :10,000), if 
discharge is great, 610 

Methyl blue, 334 

Peroxide of hydrogen, 610 

Poultices and bandages contraindicated, 
610 

Protargol, 5 to 20 per cent, solution, 610 

Protargol and argyrol, 20 to 25 per cent, 
solution in place of silver nitrate, 611 

Silver nitrate, solution (gr. 2 to 5 to the 
ounce [0.12-0.30:30.0]), if there is muco- 
purulent discharge. If discharge is ex- 
cessive, employ gr. 10 to the ounce (0.60: 
30.0), and neutralize excess with salt 
solution or wash with tepid water, 610 

Smoked glasses, 601 

Sodium bicarbonate, gr. 4 to 8 to the ounce 
(0.25 to 0.5:30.0), 610 

Tannin and glycerin (gr. 10 to the ounce 
[0.60 :30.0]), or alum crystal if there is a 
chronic tendency, 610 

Zinc oxide, 369 

Zinc sulphate solution (gr. 1 to 2 to the 
ounce [0.06-0.12:30.0]), alone or with 
boric acid, if there is chronic tendency, 
459, 610 

CONSTIPATION, 615 

Aloes, 73; and podophyllin, with other 
drugs, useful for temporary use; pre- 
scription for, 618 

Belladonna, 116 

Bryonia, when intestinal secretions are 
deficient, 133 

Cascara sagrada, the best curative agent, 
dose, HI 10 to 40 (0.60-2.60) of fluid ex- 
tract or drachm 1 (4.0) to 6 (24.0) of 
cordial, 156, 157, 617 

Castor oil ultimatelv harmful in all cases, 
158, 617 

Colocynth, jalap, or senna, not to be used 
constantly, 617 



Compound cathartic pill, sometimes neces- 
sary, 618 
Diet, of extreme importance, 616 
Enemata, as a routine treatment, harmful, 

619 
Glycerin, suppositories or enemata, often 

used, 260, 619 
Gymnastic movements, horseback riding or 

massage, with regulated diet, 616 
Hunyadi, Carlsbad, or Friedrichshall wa- 
ters, rarely of value in chronic forms, 

617 
Leptandra, fluid extract of, in intestinal 

atony, 309 
Lobelia, in combination with cascara 

sagrada, useful in atonic forms, 312 
Magnesium sulphate by the mouth or by 

enema, 315, 617 
Manna, as a laxative fruit for adults, or 

drachms 1 to 2 (4.0-8.0) to bottle of 

milk, for infants, 316, 618 
Mercury, as an habitual purgative harmful, 

321, 617 
Opium in reflex constipation, 362, 618 
Phosphate of sodium, useful in rickety 

children, gr. 5 to 10 (0.30-0.60); or 

adults, 381, 618 
Pilula cathartica vegetabilis, may be re- 
quired, 618 
Rhubarb, usually harmful, in some cases 

in children, useful, 400, 617 
Salines, simply to unload bowels, 617 
Seidlitz powder, 416 
Senna, said to be useful in constipation of 

pregnancy, particularly if combined with 

cascara sagrada, 417 
Soap suppositories, useful in children, 419 
Stillingia, recommended when habitual; 

prescriptions for, 427 
Sulphur, especially valuable if hemorrhoids 

are present, 432 
Tobacco, sometimes used, 619 

CONVULSIONS. 

Allium, as a poultice, over spine or feet in 
infantile spinal or cerebral convulsions, 
71 

Amyl nitrite, 84 

Chloral with bromide, in infants; also useful 
alone in uremic and puerperal convul- 
sions, if no acute renal trouble exists, 127 
164 

Chloroform, 179 

CORNS, 619 

Fowler's solution, locally applied, 104 
Salicylic acid, the best application, formula 

for, 406, .619 
Silver nitrate solution (gr. 60 to the ounce 

[4.0:30.0]), applied to soft corns every 

four or five days, 619 

CORYZA, 619 

Aconite, useful in early stages, 62 
Adrenalin locally to relieve engorgement, 

436, 619 
Allium, as a poultice to breast, or in emul- 
sion or boiled in milk, for children, 71 



874 



INDEX OF DISEASES AND REMEDIES. 



Antipyrin, in gr. 2 to 4 to the ounce (0.12 to 
0.25:30.0), as a spray, preceded by a 
cocaine spray, 94, 620 

Arsenic, taken for months, often cures per- 
sistent colds, 103 

Belladonna in, 118, 620 

Bromides useful in headache, 620 

Camphor, as a snuff, or inhalation of spirit, 
or fumes, when sneezing and lachryma- 
tion are excessive, 142, 143 

Cocaine, a few minims of a 4 per cent, solu- 
tion dropped into nostril, followed by 
lotion (see prescription) with atomizer, 
202, 619 

Cubebs, as a snuff during stage of secre- 
tion, 222 

Glycerin, applied alone by brush or spray, 
often of service, 260 

Hamamelis, useful after acute stage is past, 
265 

Hot mustard foot-bath with hot draught 
or Dover's powder, followed by rest in 
bed, may relieve, 620 

Inhalation of tincture of iodine, 286 

Iodide of potassium, at beginning will often 
abort, 280 

Menthol, very useful, 375 

Prescription for wash, 620 

Quinine, internally, combined with chlo- 
ride of ammonium, useful after secre- 
tion is established, 620; also useful as a 
spray, 194 

Sodium bicarbonate, gr. 30 (2.0) every two 
hours for three doses, of much benefit, 
620 

Sweet spirit of nitre, 438, 620 

Tartar emetic, 88 

COUGH. 

Acacia, as a mucilaginous drink with flax- 
seed and liquorice, to loosen hacking 
cough, 53 

Almond, essential oil of, in emulsion, as a 
demulcent in cough of phthisis, 72 

Belladonna, the best remedy in nervous 
cough, 116 

Cannabis indica, a useful adjunct to cough 
mixtures, 145 

Chloroform, useful, added to cough mix- 
tures for irritant cough, 182 

Codeine, useful in nervous cough, 207 

Flaxseed tea, alone or with paregoric, a 
useful demulcent in excessive cough, 252 

Gelsemium in nervous cough, 257 

Heroin, 265 

Honey, 267 

Hydrocyanic acid, highly recommended, 
prescription for, 272 

Hyoscyamus in nervous cough, 275 

Hypnal, 277 

Iodine, as a paint over supraclavicular 
spaces, in irritative cough, 285 

Ipecac, in spray, useful in chronic winter 
cough, 291 

Morphine in wild-cherry syrup useful in, irri- 
tative cough and when cough is greater 
than necessary to expel mucus, 362 

Paregoric (1 drachm [4.0]) in hot water, 
from which the steam is inhaled, useful 
in irritative form of cough, 362 



Sandalwood oil for excessive cough follow- 
ing influenza, 411 

Syrup of wild cherry, as a vehicle for cough 
mixtures, 397 

CRAMPS. 

Belladonna, internally or locally, as a lini- 
ment, 116 

Chlorodyne, for stomach cramp, 170 

Ginger, especially useful in menstrual 
cramp due to cold, 258. (See Dysmenor- 
rhoea.) 

CRETINISM. 

Thyroid gland very useful, 447 



CROUP (MEMBRANOUS). 

Diphtheria.) 



(See 



CROUP (SPASMODIC), 621 

Aconite useful, 62 

Amyl nitrite, inhalations, if paroxysm is 

severe, 84, 621 
Belladonna, bromides, chloral, or opium in 

small doses at bedtime, as a preventive, 

621 
Bromides and lactucarium, 621 
Bronchitis tent, 621 
Cold cloth around neck, and child placed 

at once in hot bath, air of room being 

moistened by steam, 621 
Hot compress is very useful, 504 
Menthol, useful, 376, 518, 621 
Prophylactic measures, 621 
Sanguinaria, as an emetic, unfavorable, 41 1 

CYSTITIS (ACUTE), 621 

Aconite in full dose, with sweet spirit of 
nitre and potassium citrate if there is 
fever; prescription for, 621 

Belladonna, alone or with aconite, espe- 
cially useful if due to cold; dose, 111 5 
to 10 (0.3-0.60) thrice daily, 622 

Boric acid, to render urine acid, 124 

Cannabis indica, preferable to opium for 
relieving pain, 146, 622 

Copaiba, 216 

Creolin, as a vesical wash (1 to 2 per cent, 
solution) in cystitis of women, 221 

Flaxseed tea, as a demulcent, 252 

Hot compress over bladder, should not 
contain irritants, 622 

Hot sitz-bath and enemata, to relieve 
bearing-down pain, 622 

Hygienic measures, 622 

Laudanum, V\ 30 (2.0), to starch-water 
oz. 2 (60.0), in enema, to relieve bearing- 
down pain, 622 

Leeches to perineum or cups to sacrum, 622 

Liquor potassii hydroxidi, TTX 5 (0.3) every 
four hours if urine is acid, 622 

Opium belladonna, or iodoform supposi- 
tory, to allay bearing-down pain, 362, 
622 

Quinine, contraindicated, 622 

Salines, in earlv stage to evacuate bowel, 
622 

Salol (phenyl salicylate), gr. 10 (0.60) thrice 
daily if inflammation becomes purulent, 
622 



INDEX OF DISEASES AND REMEDIES. 



875 



Urotropin (hexamethylenamine) in ammo- 
niacal cystitis, 452, 622 

CYSTITIS (CHRONIC), 622 

Arbutin, gr. 3 to 5 (0.20-0.3), or fluid ex- 
tract of buchu or uva ursi, \ to \\ 
drachms (2.0-^6.0), to improve vesical 
mucous membrane when inflammation 
is of subacute type, 452, 623 

Benzoate of ammonium, urotropin, or boric 
acid, gr. 5 to 10 (0.3-0.60) in pill, to 
render urine alkaline, 80, 623 

Benzoic acid useful when urine is alkaline 
and loaded with phosphates, 119 

Buchu, 133, 623 

Cantharides, 148, 623 

Chloretone solution useful, 623 

Creolin solution (1 to 2 per cent.), as a 
vesical douche, 624 

Grindelia, as a vesical stimulant, 260 

Juniper of value, 301 

Mercurol solution, 623 

Mercury bichloride solution (1 :10,000), as 
an injection to cleanse bladder, 623 

Myrrh often of service, 338 

Opium suppositories, gr. \ to \ (0.015-0.03) 
very useful, 362 

Pareira, 373 

Potassium salts, except bitartrate, to 
render urine alkaline when mucus is 
excessive, 623 

Salol (phenyl salicylate), 623 

Sandalwood oil, 411 

Silver-nitrate solution (gr. 1 to oz. 4 [0.06 : 
120.0] increased gradually to gr. 2 to oz. 
1 [0.12:30.0]), as an injection when dis- 
charge is mucopurulent, followed by 
salt solution if pain is severe, 623 

Strychnine and cantharides, when vesical 
atony is great, 623 

Turpentine, oil of sandalwood, cubeb, or 
copaiba, useful when vesical atony is 
great, 623 

Urotropin or uritone, 623 

DEBILITY. 

Arsenic, with bitter tonics, very useful, 101 

Calomel, in debility of children, often re- 
lieves, 328 

Capsicum for gastric atony, 149 

Eupatorium, a good tonic, 250 

Lime salts, 139 

Phosphorus, of service in sexual debility, 
384 

Sodium cacodylate in debility of tubercu- 
losis, 421 

DELIRIUM TREMENS. 

Apomorphine to produce nervous quiet, 

98 
Chloral, of great service used cautiously, 

164 
Croton oil, 222 
Hops, 269 

Hyoscine, in insomnia, 276 
Monobromated camphor, when nervous 

twitching is troublesome, 144 
Valerian with morphine, frequently used, 

453 



DERMATITIS. 

Chloride of ammonium lotion, when duo 
to ivy-poisoning, 82 

Grindelia robusta in solution one of the 
best lotions in ivy-poisoning, 261 

Lead acetate useful in ivy-poisoning, 307 

Lead-water and laudanum in ivy-poison- 
ing, 307 

Lobelia infusion as a lotion in ivv-poison- 
ing, 312 

DIABETES INSIPIDUS, 624 

Arsenic, 103 

Belladonna or opium, if due to nervous 

irritability, 624 
Carbonate or citrate of lithium, gr. 10 

(0.60), with sodium arsenite, gr. ^ , 

(0.002), valuable in gouty types, 311 
Ergot, in combination with bromide of 

sodium, 236, 624 
Gallic acid, alone or with opium, one of 

the best remedies, 254, 624 
Opium, 363 

Rhus aromatica, highly recommended. 401 
Strychnine and sulphate of iron, as tonics, 

624 
Suprarenal gland useful in, 624 

DIABETES MELLITUS, 624 

Acidulated water or non-purgative alka- 
line water, to allay thirst, 626 
Almond bread, bran bread, or artificial 

milk, as a food for diabetics, 72, 552 
Alum, 76 
Antipyrin, 93, and arsenate of sodium and 

carbonate of lithium when of gouty 

origin, 93, 625 
Carbonate of sodium, by intravenous in- 
jection in diabetic coma, 627 
Chloride of gold and sodium, gr. ^ (0.006), 

recommended, 625 
Codeine, in ascending doses, beginning gr. 

1 to 5 (0.06-0.30), thrice daily, 207 
Colchicum and iodides, in gouty types, 625 
Diet, 624, 625 
Ether hypodermically, to support heart 

in diabetic coma, 627 
Gallic acid, with opium, one of the best 

remedies, 254 
Glycerin or saccharin, as sweetening agents 

to replace sugar, 260, 403, 626 
Iodol, gr. 2 to 6 (0.12-0.40), thrice daily, 

recommended, 289 
Iron, lacto-phosphates of lime and sodium, 

strychnine and astringents, if cachexia 

comes on, 626 
Jambul, gr. 5 to 30 (0.3-2.0), once to thrice 

daily, said to be very useful in some 

cases, 626 
Levulose, 309 
Lime-water, 140 
Lithium carbonate or citrate, with arsenic, 

very useful, if due to gout, 311, 625 
Morphine, very useful in ascending doses, 

625 
Opium, gr. i to ^ (0.015-0.03), thrice dailv, 

largely used, 363, 625 
Pancreas of doubtful value in pancreatic 

diabetes, 259 



76 



INDEX OF DISEASES AND REMEDIES. 



Panoreatin, when the disease is due to a 

lesion of the pancreas, 372 
Purgatives, restricted diet, and exercise, 

if due to high living and sedentary 

habits, 625 
Salicylates and iodide of potassium, if due 

to rheumatic or gouty taint, 625 
Sodium bicarbonate, oz. £ to 1 (16.0-30.0) 

daily when coma is feared, because of 

increase in acetone in urine, 627 
Transfusion, in diabetic coma, 538, 627 

DIARRHCEA. 

Allspice, 72 
Arsenic, 103 
Belladonna, may be used in serous types, 

116 
Beta-naphthol-bismuth, in serous and fer- 
mentative types, 339 
Bichloride of merciny, gr. -^iv (0.0003), 

hourly, if stools be slimy and bloody, 

326, 630 
Bismuth, with phenol, gtt. 1 to 2 (0.05-0.1), 

highly recommended in serous and slim- 
mer diarrhoeas, 120, 629 
Cajuput, TTl 10 to 20 (0.60-1.3), in serous 

forms, 137 
Calomel, followed by a saline, useful in 

sthenic cases of summer diarrhoea, 629 
Calumba, in summer and serous diarrhoeas, 

prescription for, 140 
Camphor, useful in serous but never in 

mucous types, 142, 629 
Castor oil, with laudanum and sodium 

bicarbonate, to unload bowel and render 

it alkaline, 158, 628 
Chalk mixture, with kino and gambir, in 

serous diarrhoeas, prescription for, 137 
Charcoal, useful in acid and fermentative 

types, 158 
Chirata, nitro-muriatic acid, or, better 

still, nitric acid and cardamons, in 

mucous type, prescription for, 628 
Chlorate of potassium for acute rectal 

catarrh with mucous diarrhoea, 168 
Chlorodyne, largely used in serous types, 

170. 
Chloroform, with astringents and opium, 

verjr useful after removal of irritant 

cause, 182, 629 
Cinnamon, as a stimulant in serous types, 

197 
Cloves, to prevent griping, 199 
Copper sulphate, gr. •£ (0.015) with opium, 

gr. 1 (0.06) in pill, or in enema, gr. 5 to 

20 to the ounce [0.3-1.3:30.0]), if due 

to ulceration, 217 
Creolin in entero-colitis, 5:1000 of water, 

221 
Diet, for summer diarrhoea, 628 
Enteroclvsis, when mucous form becomes 

chronic, 499, 631 
Ergot, sometimes useful in serous types, 

235 
Eudoxine, as an intestinal antiseptic in 

children, 249, 629 
Gallic acid, 254 
Gambir, alone or with opium, in serous 

types, prescription for, 255 



Geranium, 1 to 2 roots, boiled in pint of 
milk, of great service in infantile types, 
and in serous diarrhoea, 258 

Ginger, a good addition to diarrhoea mix- 
tures, 258 

Guaiacol carbonate, in fermentative forms, 
of, 264 

Ha^matoxylon, useful in children, because 
of agreeable taste, 264 

Hope's camphor mixture, in serous and 
choleraic types, 268 

Ipecac, gr. i to i (0.015-0.03) thrice daily, 
useful in summer diarrhoea of childien, 
291, 630 

Kino, formula for, 302, 629 

Lead acetate, with opium and camphor 
in serous types, prescription for, 306, 
628 

Mercury, with chalk or calomel, in hepatic 
disorder, 330, 629 

Morphine, gr. ^ to^ (0.0008-0.0012) hypo- 
dermically, often checks summer diar- 
rhoea in children, 363 

Mustard plaster, or other counterirritants, 
to abdomen, 628 

Naphthalene or naphthol, in fetid and sum- 
mer diarrhoea, 339, 629 

Nitrate of silver and hyoscyamus, or lead 
acetate and opium, in mucous diarrhoea, 
prescription for, 628, 631 

Nitro-muriatic acid, or podophvllin, gr. 
ik to ?V (0.0012-0.0015), in 'summer 
diarrhoea, if duodenum is at fault, 348, 
630 

Nutmeg, useful in serous types, 351 

Opium, 363, 628 

Pancreatin in lienteric diarrhoea, 372 

Pepsin with hydrochloric acid in summer 
diarrhoea, if gastric digestion is deficient, 
630 

Phenol, especially useful as an intestinal 
antiseptic, 153 

Phenolsulphonate of zinc, 2 grains (0.12) 
every three hours; of service in summer 
diarrhoea, 629 

Phenolsulphonates, 381 

Phosphate of sodium, lime salts, and com- 
mon salt in summer types, if rickets is 
present, 381, 630 

Podophyllin, 393, 630 

Precipitated carbonate of calcium, in 
serous diarrhoea, 137 

Raspberry-leaves, used in domestic medi- 
cine, 402 

Rhubarb, often useful, preceding direct 
treatment in summer diarrhoea, 400 

Salol (phenyl salicylate) combined with 
chalk mixture, 410, 629 

Sulphate of iron in chronic forms, 299 

Sulphuric acid, especially valuable in 
serous types, prescription for, 434, 629 

Tannic acid, in atonic or serous tvpes, 439, 
631 

Tar mixture, highly recommended in ob- 
stinate types, formula for, 440 

Thymol, naphthalene, and especially sali- 
cylic acid, useful in intestinal antisep- 
tics, in summer diarrhoea, 629 

Zinc oxide, in summer types, prescription 
for, 369 




INDEX OF DISEASES AND REMEDIES. 



877 



Zinc sulphate, 2-grain (0.12) pills, especially 
useful with opium, or podophyllin, gr. 
ek (0.001), in serous types, 459 

DIARRHOEA (CHRONIC), 631 

Ammonium chloride, gr. 5 (0.3) every four 
hours, best remedy in persistent catarrhal 
states, 632 

Arsenic, 103 

Bismutlai et ammonii citras, in chronic 
serous types, 120 

Diet, 631 

Ipecac, gr. 3 (0.20) every two hours, of 
service, 291 

Iron sulphate, gr. 5 (0.3) in pill, in chronic 
types, 299 

Nitric acid, with a bitter tonic, useful in 
green diarrhoea of children, combined 
with pepsin, 345 

Operative procedures when due to lesions 
of the rectum, 632 

Potassium iodide, gr. 3 to 5 (0.20-0.3) if 
catarrhal state is obstinate, 632 

Rockbridge alum water, useful when anae- 
mia is present, 632 

Silver nitrate in pill form, or in other cases 
rectal injections of this drug, gr. 2 to 
oz. 1 (0.12-30.0), foUowed by iodoform 
suppository, of greatest benefit, 632 

DILATATION (GASTRIC AND INTES- 
TINAL). 

Physostigma with nux vomica, 386 

DIPHTHERIA, 632 

Aconite, in earh T stages, 62 

Alum, 76 

Antistreptococcic serum, 470 

Antitoxin, of great value; 2000 to 5000 
units should be thrown into the connec- 
tive tissues of the back. A special 
syringe is used for this purpose, and 
should be perfectly aseptic, 46S, 633 

Borax solution as a gargle in, 123 

Bronchitis tent, 636 

Calomel by sublimation, of great good in 
some cases, 636 

Carbolic acid (1 :100) in the form of spray 
or gargle, 154 

Chlorate of potassium, contraindicated for 
internal use, because of danger to the 
kidneys. It may be applied upon a 
swab, 167, 637 

Corrosive sublimate to prevent fibrinous 
exudation, 326 

Hypodermoclysis, 636 

Ice-bags to the neck, ice in the mouth and 
the tincture of the chloride of iron inter- 
nally, if glandular suppuration threatens, 
636' 

Irrigation of the nasal chambers useful in, 
633 

lime-water as spray or application very 
useful in, 141 

Loeffier's application (menthol, dr. 2h 
[10.0], dissolved in dr. 9 [34.0] of toluol; 
add dr. 1 [4.0] of liquor ferri chloridi and 
absolute alcohol, fl. oz. 2 [60.0]), 635 

Milk diet. 636 



MonsePs solution, as a topical application, 
298 

Oxygen inhalations, strychnine, and atro- 
pine if suffocation is imminent. Intu- 
bation or tracheotomy may be necessary, 
637 

Peroxide of hydrogen is the best local ap- 
plication. May be applied on a swab or 
as a sprav (1 :4), to remove false mem- 
brane, 274, 632 

Potassium permanganate, solution (gr. 20 
to the pint [1.3 480.0]), applied as a 
swab or gargle, 377 

Salt solution (7:1000), as a sprav in nasal 
diphtheria, 633 

Tincture of the chloride of iron, 296, 636 

Tonics, such as quinine, strychnine, and 
the chloride of iron, as supportive meas- 
ures, 636 

Turpentine, bv inhalation, prescription for, 
636 

DROPSY, 637 

Acupuncture, less favorable than incisions, 
only to be resorted to after other reme- 
dies fail, 461 

Adonidin useful in cardiac dropsy, 63 

Apocynum, in cardiac or renal dropsy of 
the subacute or chronic type, 96, 640 

Caffeine, in cardiac or renal drops}', 136; 
in torpidity of kidneys, 640 

Calomel and digitalis, in renal and cardiac 
types, 328, 640 

Colocynth, compound extract of, gr. 2 to 
6 (0.12-0.40), 213, 639 

Copaiba, of service in slow renal tvpes, 216 

Digitalis, TTl 5 to 15 (0.30-1.0), with can- 
tharides, TT[ 1 (0.05), thrice daily, in renal 
torpidity due to heart trouble, 640 

Elaterium, especially useful in renal dropsy, 
233, 639 

Jalap, compound powder of, gr. 20 to 30 
(1.3-2.0), with potassium bitartrate, gr. 
10 (0.60), added, especially serviceable 
in renal dropsy, 300, 619 

Magnesium sulphate, in concentrated solu- 
tion, before breakfast, 315, 639 

Milk diet, very useful, 640 

Paracentesis abdominis, very useful in 
ascites, 640 

Pilocarpine, useful in localized and renal 
dropsv, contraindicated in cardiac tvpes, 
389, 640 

Potassium bitartrate with gin in dropsy 
due to chronic nephritis, 122 

Potassium iodide, in hepatic cirrhosis and 
localized effusions, to remove liquid, 641 

Scoparius, infusion, may be used, 416 

Senega, rarely of value, 417 

Squill with digitalis, prescription for, 425, 
640 

Strophanthus in cardiac dropsy, 429 

Sugar of milk, useful as a diuretic, 430, 640 

Tapping in ascites, the best method, 640 

DYSENTERY, 630 

Alum, internally, 76 
Arsenic, 103 

Bichloride of mercury, gr. ^h (0.0003), if 
passages are slimy and bloody, 326, 630 



878 



INDEX OF DISEASES AND REMEDIES. 



Bichloride of mercury, injections (1:5000), 
followed by solution (1:30,000) to pre- 
vent toxic effect by absorption, 631 

Boric acid, 3j to Oj (4.0:480.0), or phenoJ- 
sulphonate of zinc, gr. 15 to 1 quart (1.0 : 
960.0), very useful as rectal injection, 
631 

Calomel, in purgative dose, contraindicated 
if weakness exists, 328, 630 

Continuous irrigation with two-way tube, 
of great value, 631 

Copaiba, 216 

Creolin enemata, 221 

Ergot, useful in bloody stools, 235 

Hamamelis, injections, if much blood is 
present, 530 

Ice-water injections, if due to inflamma- 
tion, used only in strong persons, 475, 
630 

Ipecac, best remedy in acute dysentery, 
291, 630 

Irrigation of colon, 500 

Lead acetate, with opium and camphor, 
prescription for, 307 

Nitro-hydrochloric acid, if due to defective 
action of secretory glands, 348 

Prescription for enema, 630 

Quinine injections useful in amoebic dysen- 
tery, 195, 631 

Silver nitrate, rectal injections (gr. 10 to 
20 to the pint [0.6-1.3:480.0]), if ulcers 
are chronic; followed by salt solution if 
action is too severe, 342, 631 

Sulphate of magnesium, 315, 630 

Tannic acid (5j [4.0] to water Oj [480.0]), 
in the form of intestinal irrigation, 631 

Taraxacum in dyspepsia due to hepatic 
torpor, 441 

DYSMENORRHEA, 641 

Amyl nitrite, often relieves, 84 

Antipyrin or acetanilid, in neuralgic at- 
tacks; in other cases of doubtful value, 
93, 642 

Belladonna, suppository, gr. £ (0.03), of 
extract of ointment applied to os; tinc- 
ture, internally, useful to relax spasm, 
116, 641 

Camphor with acetanilid, in pill, useful in 
nervous cases, 142 

Cannabis indica and gelsemium, often of 
service, 146, 642 

Epsom salts or aloes, if constipation is 
present, 641 

Ether or bromide of ethyl, 642 

Gelsemium in spasmodic forms, 257, 642 

Hot sitz-bath, followed by turpentine 
stupe, and Dover's powder, gr. 10 (0.60), 
often relieves, 505, 641 

Iron, strychnine, and quinine, as tonics, 
with rest and horseback riding for 
anaemic and run-down patients, 642 

Opium, to relieve spasm and pain, 361, 
641 

Piscidia erythrina, extract, in the dose of 
from I- to 2 fluidrachms (2.0-8.0), 392 

Potassium bromide, 128 

Water, cold and hot, alternately dashed 
over loins in atonic cases, 642 



DYSPEPSIA. (See Indigestion.) 

Ammonium chloride in painful dyspepsia 
due to hyperacidity, 82 

Arsenic, useful in atonic types associated 
with chronic diarrhoea, 103 

Benzo-naphthol, in fermentative dyspepsia 
339 

Bismuth subgallate in fermentative dys- 
pepsia, 122 

Bismuth, when due to acid fermentation 
121 

Bryonia, when due to gastric and intestinal 
atony, 132 

Gentian, 257 

Hydrastis, as an antisepsic and curative 
agent in chronic types, 269 

Hydrochloric acid, if gastric secretion is 
deficient, 271 

Lavage in fermentative dyspepsia, 524, 712 

Nitric acid with bitter tonics often relieves 
intestinal types, 345 

Permanganate of potassium, 377 

Quassia, useful, if not due to gastritis, 397 

Serpentaria, as a tonic in atonic types, 418 

Strontium bromide, in painful dyspepsia, 
428 

Terebene, useful as an antiseptic in fer- 
mentative dyspepsia, 441 

DYSPNEA, 642 

Ammonium carbonate, as a respiratory and 
cardiac stimulant, 643 

Arsenic, continuously employed, useful in 
emphysema and chronic pulmonary in- 
flammation, 643 

Dry cupping over back, when diie to car- 
diac or pulmonary trouble, 643 

Heroin said to be of value in uraemic dysp- 
noea, 266 

Hyoscine, contraindicated, 643 

Morphine, gr. i to \ (0.008-0.015), night 
and morning, often cures when due to 
nervous or cardiac disorders, 364, 643 

Opium, if due to nervous disorders, 643 

Strychnine, in idiopathic types and when 
due to bronchorrhoea in old people, 354, 
643 

Thoracentesis if there is pleural effusion, 
643 

EAR (DISEASES OF). 

Bismuth subgallate, useful in purulent 
otitis media, 122 

Glycerin, useful to soften impacted ceru- 
men, 260 

Potassium permanganate, solution, useful 
in purulent otitis media, 377 

EARACHE, 643 

Cardiac sedatives, 643 

Chloroform, on swab, behind and in front 
of ear in otalgia, 645 

Cocaine, Til 1 to 3 (0.5-0.20) of a 4 per cent, 
solution or adrenalin chloride (1 :5000 
solution), dropped into nostril, followed 
by spray if mucous membrane is en- 
gorged, 644 

Heat, dry, applied to head on affected side, 
644 



INDEX OF DISEASES AND REMEDIES. 



879 




Inflation of Eustachian tube with Politzer's 
air-bag, 644 

Irrigation with normal salt solution hot as 
can be borne, gives great relief, 644 

Leeching behind ear, to relieve pain, 643 

Menthol and alboiene spray, following 
cocaine, 644 

Poultices, oil, and laudanum, contraindi- 
cated, 644 

Puncture of tympanum, if it bulge, fol- 
lowed by careful cleansing and insuffla- 
tion of boric acid, 644 

Tincture of belladonna and of opium 
dropped into the ear, 644 

ECLAMPSIA, 774 

Amyl nitrite, dangerous, 84 

Chloral and bromide, each 1 drachm (4.0), 

by rectum, before applving hot pack, 

775 
Chloroform, pushed rapidly as possible, at 

onset of attack, 775 
Elaterium, gr. \ (0.015), rubbed up with 

butter, or compound jalap powder and 

calomel, may be substituted for croton 

oil, 775 
Ether, as an anaesthetic, contraindicated, 

775 
Extraction of child rapidly as possible, if 

attack comes on during labor, 775 
Ice-bag to head while in warm pack, 775 
Morphine, veratrum and amyl nitrite, 

may be held in reserve, to be used if 

necessary, 775 
Pilocarpine contraindicated, 775 
Transfusion, 538 
Venesection, hot wet pack, and croton oil, 

TT1 2 (0.1), with sweet oil on tongue, to 

eliminate poison, 775 
Veratrum in full doses, 456, 775 

ECZEMA, 645 

Ammoniated mercury in chronic dry form, 

324 
Arsenic, only when skin is very dry, 102 
Bismuth subgallate in weeping eczema, 

122 
Black wash of value in, 327, 645 
Calamine in moist eczema, 458 
Cantharis, internally in small doses, 148 
Dermatol in weeping eczema, 122 
Green soap, 419, 646 
Hygienic measures and diet, 645 
Ichthyol ointment, highly recommended, 

278 
Internal treatment, 647 
Iron, syrup of iodide, in young children 

with anaemia and debility, 297 
Kaolin as a dusting-powder, 302 
Lead, dilute solution of subacetate, a 

useful lotion, 308 
Liquor carbonis detergens, in acute cases, 

466 
McCall Anderson's ointment, 645 
Methyl blue in eczema of the eyelids, 333 
Ointments, prescriptions for, 368, 646 
Phenol ointment (minims 10 [0.60] to 

cerate 1 ounce [30.0]), to prevent itch- 
ing, 154, 646 



Poultices, or olive oil with phenol (TT\ 1 to 
2 to the ounce [0.05-0.1 :30.0]), followed 
by soap and water, necessary in some 
cases to soften scales, before use of oint- 
ment, 646 

Prescription of iodol, as an ointment, about 
nose and lip, 290 

Resorcinol ointment (gr. 2 to 30 to the ounce 
[0.12-2.0:30.0]), locally applied in sub- 
acute types; in chronic form ointment 
(gr. 2 to 10 to the ounce [0.12-0.60 :30.0]), 
375, 607; solution, gr. x to xv C0.6-1.0) 
to f o j (30.0), in itching of erythematous 
form, 399, 646 

Salicylic acid ointment (gr. 30 to 60 [2.0- 
4.0] to lard 1 ounce [30.0]), in chronic 
or weeping types, 407, 646 

Starch poultice, in crusty eczema, 426 

Tar ointment, in chronic forms, 440, 646 

Thiol, as a dusting-powder, preceded by 
an antiseptic wash, especially suited to 
moist eczema, 443 

Unna's dressing, 368 

Zinc carbonate, as a protective powder in 
weeping eczema, 458 

Zinc oxide, as a dusting-powder or oint- 
ment in early stages, applied directly 
or on lint, generally preceded by black 
wash, 368, 645 

EMISSIONS, 647 

Bromide of sodium or potassium, gr. 20 

(1.3), at bedtime, valuable in spinal 

irritability, 127, 648 
Chloral, gr. 20 (1.3), at bedtime, 648 
Cold sponging of perineum and scrotum, 

474, 648 
Gold and sodium chloride in nocturnal 

emissions, 261 
Hygienic measures, 647 
Hyoscine, gr. ^ (0.0006), of great value, 

276, 648 
Monobromated camphor very useful in 

spermatorrhoea, 144 
Potassium citrate, gr. 20 (1.3), thrice daily, 

to render urine non-irritating, 648 
Strychnine and arsenic, in full dose, of 

great service in genital atony, 648 
Warm bath before retiring, often useful, 

648 

EMPHYSEMA OF LUNGS. 
Cod-liver oil, useful, 209 
Ethyl iodide, 248 
Euphorbia pilulifera, \ to 1 drachm (2.0- 

4.0) of the fluid extract, 251 
Iodide of potassium, 281 
Physostigma, aids in expelling mucus, 380 
Strychnine, 354 

EMPYEMA. 

Iodine, gr. 6 (0.4) ; potassium iodide, gr. 6 
(0.4); water, 1 pint (500.0), as an irri- 
gating fluid, used daily, 286 

ENDOCARDITIS, 648 

Aconite, tincture of, TTl 6 to 10 (0.4-0.6), 
hourly, in early stages of acute sthenic 
types* 648 



880 



INDEX OF DISEASES AND REMEDIES. 



Antistreptococcic serum in ulcerative endo- 
carditis, 470 

Blisters on praecordium, to prevent endo- 
cardial complications, 649 

Ice-bag over prsecordium, 473, 648 

Iron, tincture of chloride, associated with 
supportive treatment, in purulent types, 
649 

Veratrum, used for same purposes as 
aconite, 648 

ENTERIC FEVER. (See Typhoid Fever.) 

ENTERITIS. (See Dysentery and Diar- 
rhoea.) 

EPIDIDYMITIS, 679 

Guaiacol used locally highly recommended, 
264 

Heat, moisture, and pressure, in later 
stages, to relieve induration, 679 

Horand-Langlebert's dressing, 679 

Ice-bags, 679 

Iodide of potassium, gr. 3 to 5 (0.20-0.30), 
thrice daily, to remove induration, 
680 

Iodine, painted over scrotum, said to be 
beneficial, 493, 679 

Mercury and belladonna ointments, equal 
parts, or iodine, gr. 4 (0.25), with lanolin, 
ounce 1 (30.0), locally applied, to relieve 
induration, 680 

Punctures, useful to relieve tension and 
alleviate pain, 679 

Rest in bed, elevation of pelvis and testi- 
cles, cessation of local gonorrhceal treat- 
ment, and administering treatment for 
acute inflammation, 679 

Silver nitrate, solution, painted over scro- 
tum, in early stage, mav relieve, 343, 
493. 679 

Strapping and suspending testicle, to re- 
duce inflammation, 493, 679 

EPILEPSY, 649 

Acetanilid, 57, 655 

Adonis vernalis with bromides have been 

found useful, 63, 652 
Ammonium or sodium nitrite, used to 

supplement amyl nitrite, 654 
Amyl nitrite, inhalations, when aura is 

perceived and also in status epilepticus 

to relax spasm, 84, 654 
Anaesthetics contraindicated in all cases 

except status epilepticus, when chloro- 
form may be used to control attack, 

654, 655 
Antifebrin and antipyrin especially useful 

in some cases, 93, 655 
Belladonna, with bromides, recommended, 

653 
Bleeding for the status epilepticus, 654 
Borax may be used, 123, 656 
Bromide of ammonium, should be used 

with other drugs, 81, 652 
Bromide of calcium, 130 
Bromide of gold, 130 
Bromide of iron, when anaemia is present, 

652 



Bromide of lithium, highly recommended 
in some cases, 130, 652 

Bromide of nickel, 131 

Bromide of potassium, the most reliable, 
in ascending dose, 126, 649 

Bromide of sodium, not so apt to disorder 
stomach, 652 

Chloral, alone or with bromides, well 
diluted, after meals, used with care, 166 
655 

Diet, 656 

Digitalis, with bromides, useful in some 
cases, 653 

Duboisine, especially in psychic forms, 233 

Hydrobromic acid, liable to derange diges- 
tion, 652 

Iodide of potassium, useless except in 
syphilitics, 655 

Mercury, associated with potassium iodide, 
when due to gumma, 655 

Mixed treatment, 652 

Monobromated camphor, 144 

Nitroglycerin, useful in some cases of 
petit mal, 346, 654 

Opium with gelsemium, only to be used 
when other remedies fail; also a pro- 
longed course of, in ascending doses, 
useful in old cases, 653 

Potassium nitrite, 345 

Quassia injections, when due to worms; 
if not obtainable, sodium chloride solu- 
tion may be used, 656 

Silver nitrate, may be tried when other 
remedies fail, 342, 653 

Solanum carolinense, fluid extract of, 2 to 
15 minims (0.1-1.0), thrice daily, in 
the epilepsy of childhood, 423, 656 

Strontium bromide, 428 

Tartar emetic ointment, as a counter- 
irritant at back of neck, 88 

EPISCLERITIS, 656 

Antiseptic collyria, 657 

Atropine locally, 657 

Iodide of potassium and salicylates, 657 

EPISTAXIS, 657 

Acetanilid, used locally, has been recom- 
mended, 57 

Acetic acid, locally applied, to arrest, 59 

Aconite or veratrum, tincture, tt[ 6 to 12 
(0.4-0.8) in sthenic cases, followed in 
thirty minutes by smaller doses, if 
necessary, 62, 657 

Adrenalin locally, 436, 657 

Alum powder, pure or half-and-half with 
starch, as a snuff, 657 

Bacon fat, inserted as a plug in nostril, 
may arrest, 657 

Compression of facial artery may be neces- 
sary, 658 

Cotarnine, locally, 218 

Ergot, turpentine, hamamelis, or oil of 
erigeron, internally, in slow oozing, 235 
657 

Hot foot-bath, or hot- or cold-water bags 
applied to dorsal vertebrae, may arrest, 
658 

Ice applied to nose, may arrest, 658 



INDEX OF DISEASES AND REMEDIES. 



881 



Ipecac, in nauseating doses, recommended, 
657 

Monsel's solution, in spray ( TT\ 30 to 4 
ounces [2.0:120.0]), only to be tried 
when other remedies fail ; very dis- 
agreeable, 298, 657 

Oil of erigeron, 237, 657 

Plugging anterior and posterior nares, if 
necessary, with cotton or lint soaked in 
vinegar, 657 

Tannic acid, in powder or solution, snuffed 
up nostril, 657 

Vinegar or lemon-juice injected into nos- 
tril, 658 

EPITHELIOMA. 

Acid nitrate of mercury, applied to part 

with glass rod, 332 
Arsenous anioxide and gum acacia (of each 

1 ounce [30.0] to water 5 fluidrachms 

[20.0]), locally applied, 104 
Resorcinol, in epithelioma of the face, 399 

ERYSIPELAS, 658 

Alcoholic stimulants if patient passes into 
typhoid state, 658 

Antistreptococcic serum, 470 

Bitters and iron, during convalescence, as 
tonics, 658 

Boric acid, as a lotion, 123 

Cold bathing to control excessive fever. 
658 

Ichthyol ointment and vaseline, half-and- 
half, locally applied, preceded by wash- 
ing with Castile soap, followed by bi- 
chloride solution (1:1000), 278, 659 

Iodine, tincture, painted around inflamed 
edges, to arrest, 285 

Iron, tincture of chloride, TT] 20 to 40 
(1.3-2.6), thrice dailv, best internal 
treatment, 295, 658 

Pilocarpine, gr. £ to £ (0.008-0.01), hypo- 
dermically, contraindicated in debility ; 
also injected around borders of inflam- 
mation in some cases, to arrest, 390, 658 

Silver nitrate, solution (gr. 80 to the \ 
oimce [5.3:16.0]), applied twice or 
thrice, to arrest, 343, 659 

White-lead paint, locally applied, when 
ichthyol is not at hand, 659 

EXHAUSTION AND DEPRESSION, 660 

Stimulants, 660 

EXOPHTHALMIC GOITRE. 

Belladonna relieves some cases, 118 
Sparteine, 416 

EYE-STRAIN 659 

Correct error of refraction, 660 



FAINTING. 



Alcohol, 66 



FEET ( SWOLLEN, TENDER, OR SWEAT- 
ING), 660 
Arsenous anioxide, gr. 6 ^ to ^ (0.001- 

0.0015), in swelling of old persons, 104, 

660 



Borax, stockings soaked in saturated solu- 
tion and dried, each day, when sweat- 
ing is excessive, 661 

Carbonate of calcium, precipitated, locally 
applied to sweating feet, 137 

Cotton instead of woollen stockings may 
aid cure, 661 

Formaldehyde, 661 

Hamamelis, distilled or fluid extract, 
drachm \ to 1 (2.0-4.0) of former, or 
HI 10 to 20 (0.60-1.3) of latter, 660 

Lead plaster and linseed oil, equal parts, 
applied on linen to feet, every third day, 
for sweating, 308 

Prescription for dusting-powder, 661 

Rest, absolute, of feet, may be necessary in 
swollen feet, 660 

Salicylic acid and borax, equal parts, in 
water and glycerin, best application to 
sweating and tender feet, 661 

FELON. 

Bread-crumbs saturated with liquor plumbi 
subacetatis, as a poultice, to abort, 308 

Silver nitrate, solution, applied early, to 
abort, 343 

FEVER, 661 

Acetanilid, 56, 662 

Aconite, the best depressant for sthenic 
types in children, 62 

Alcohol, as a systemic support and stimu- 
lant in low fevers, 66, 67 

Ammonia for sudden cardiac failure in, 78 

Antimonial powders as an intipyretic, 89 

Antipyretics, useful in most sthenic fevers, 
often fail in thermic fever, 662 

Antipyrin, 92 

Brand's method, 484 

Camphor a diffusible stimulant in ady- 
namic fevers, 142 

Capsicum as a stimulant in low fevers, 150 

Coca a supportive and stimulant in low 
fevers, 204 

Cold applications and baths, 480, 662, 663 

Cold packs and baths in asthenic types to 
be relied on first; if impracticable, then 
antipyretics, 663 

Digitalis, in small doses, valuable in ex- 
hausting fevers, 229 

Guaiacol, useful in, 263 

Hydrochloric acid an adjuvant to diges- 
tion, 271 

Musk, by rectal injections, valuable in low 
stages, 337 

Neutral mixture, useful as a febrifuge, 
especially in children, 395, 396 

Phenacetin, 379 

FIBROIDS. 

Ergot, used as an expulsive and curative 

remedy, 236 
Mammary gland, for effect on bleeding and 

growth, 316 

FLATULENCE. 

Aromatic powder, 198 
Asafoetida, 110 
Camphor, 142 



56 



882 



INDEX OF DISEASES AND REMEDIES. 



Capsicum, prevents formation of gas, 150 

Charcoal, 155 

Chloroform, TT1 1 to 2 (0.05-0.1), or spirit, 

TTl 10 to 20 (0.60-1.3), will relieve, 182 
Cloves, a useful tonic and stimulant, 199 
Ginger, 258 
Hoffmann's anodyne, the best carminative, 

266 
Naphthol in gastric fermentation and 

flatulence, 339 
Pepper, 374 
Peppermint, 374 
Podophyllin with euonymin, leptandra, 

chirata, and creosote, 393 
Potassium permanganate, 377 
Turpentine, prescriptions for, 450 

FRECKLES AND CHLOASMA, 663 

Almonds, emulsion of, supposed to be of 
value, 72 

Boric acid, saturated solution, applied same 
as corrosive sublimate wash, 124, 663 

Corrosive sublimate (gr. 1 to 4 to the ounce 
[0.06-0.25:30.0]), applied night and 
morning until irritation appears, then 
stop for some days and again renew, 
663 

Lactic acid (gr. 10 to the drachm [0.60: 
4.0]), applied same as corrosive subli- 
mate, 663 

Prescription for chloasma of pregnancv. 
368 

Prescriptions for, 663 

FURUNCLES. (See Boils.) 

GALACTORRHEA, 773 

Antipyrin, gr. 2\ (0.123), thrice daily, said 
to decrease secretion, 773 

Caustic, introduced into uterus, successful 
in some cases by inducing menstrual 
flow, 773 

Chloral should be tried, 773 

Compression of gland with applications of 
belladonna ointment and potassium 
iodide internallv, usuallv relieves, 773 

Diet, 773 

Electricity, generally ineffective, 773 

Ergot, long continued, highly recom- 
mended, 773 

Malt, wineglassful at midday and evening 
meals, useful addition to diet: pyro- 
phosphate of iron, gr. 4 (0. 25), in addi- 
tion, if anaemia is present, 774 

Warm douches, 773 

GANGRENE. 

Bromine, as an escharotic in hospital gan- 
grene, 131 

Carbolic acid or creosote, spray (TTl 5 to 15 
to the ounce [0.3-1.0:30.0]), useful in 
pulmonary gangrene, 153 

Nitric acid, to destroy tissue, 344 

GASTRALGIA, 664 

Acetanilid, 57 
Alum, 76 

Arsenic with iron, the most reliable 
remedy, prescription for, 664 



Bismuth and pepsin, after meals, to pre- 
vent pain, 121, 665 

Bromide of strontium, a valuable remedy, 
427 

Bromides or valerian, alternated with other 
treatment if case is neurotic, 665 

Cannabis indica, prescription for, 146 

Chloretone, gr. 5 to 10 (0.30-0.60), is 
useful, 168, 665 

Cod-liver oil in emulsion with hypophos- 
phites, occasionally better than arsenic 
and iron, 664 

Counterirritation and a vigorous revulsive, 
especially useful in hysteria, 493, 664 

Cyanide of potassium, dilute hydrocyanic 
acid or chloroform as a substitute for 
bismuth, if it favors constipation, 665 

Diet and hygiene, 664 

Emesis and purgation, when due to indi- 
gestible food. 664 

Hot applications, stimulating infusions, 
chloroform, hot brandy or whiskey or 
laudanum, TT] 30 to 40 (2.0-2.60), during 
acute stage, 664 

Hydrocyanic acid, useful in nervous types, 
272 

Massage, enemata, diet, or suppositories of 
gluten, glycerin, or soap, to overcome 
constipation, 665 

Menthol, 375 

Nitroglycerin, 346 

Potassium nitrate, gr. 4 to 5 (0.25-0.3), 345 

GASTRIC ATONY. 

Arsenic, prescription for, in, 104 
Prescription for, in drunkards, 69 

GASTRIC CATARRH (ACUTE), 665 

Ammonium muriate, useful in subacute 
forms in children, prescription for, 82 

Bismuth subnitrate, gr. 2 (0.12) and cerium 
oxalate, gr. 1 (0.06) every two hours, 666 

Calcined magnesia, as a mild purge to dis- 
lodge fermenting mass, 666 

Diet, principal point in treatment, 665 

Effervescing draughts, useful in convales- 
cence, 666 

Flannel to protect abdomen,, 666 

Ice, to quench thirst, if anorexia is great, 
665 

Iron, if anremia exists, 666 

Milk, with large percentage of lime-water, 
665 

Salicylic acid, valuable in vomiting, 407 

Seidlitz powder, one-fourth of one powder 
every fifteen minutes, to settle stomach 
and remove fermenting mucus, 666 

Sodium bicarbonate with gentian, useful, 
257, 666 

Spice poultice to relieve epigastric distress, 
666 

Tartar emetic, given early, in acute attack 
of children, may abort, 88 

GASTRIC CATARRH (CHRONIC), 666 

Apomorphine, as an emetic, to throw off 

muciis, 98 
Arsenic for the vomiting, in hand-fed 

babies, 103 



INDEX OF DISEASES AND REMEDIES. 



883 



Bicarbonate of sodium for hyperacidity, 666 
Bismuth subnitrate, added to prescription, 

if hyperacidity exists, 666 
Carlsbad salt, Saratoga-Carlsbad water, or 

Seidlitz powder of great benefit, 668 
Cascara sagrada, if constipation exists, 667 
Charcoal, prescription for, 155 
Diet, such as koumyss, light broths, and 

matzoon, 667 
Hydrochloric acid, if due to atrophy of the 

gastric tubules, 271, 667 
Lavage almost alwaj's to be used, 666 
Silver nitrate and hyoscyamus, with coun- 

terirritation and regulated diet, 275, 342, 

666, 667 

GASTRIC DILATATION, 667 

Beta-naphthol if fermentation is marked, 
668 

Cold douches, 668 

Diet, 667 

Enemas, nutrient, often useful, especially 
in older children, 667 

Exercise, 668 

Faradization of gastric walls recently in- 
troduced, 668 

Hydrochloric acid, to aid digestion, 668 

Lavage, 524, 667 

Physostigma useful, combined with mix 
vomica, 386 

Salicylic acid as an antiseptic when vomit- 
ing occurs and when the vomited matter 
contains sarcinaa, 407 

Taka-diastase taken with meals, 667 

GASTRIC ULCER, 668 

Arsenic, 103 

Bismuth and sodium bicarbonate, as an 
astringent and sedative, and to these 
may be added morphine or codeine for 
pain, 121, 669 

Carlsbad salts, magnesium sulphate, or 
sodium phosphate, for relief of constipa- 
tion, 669 

Chloretone of value to relieve pain, 168, 
669 

Cocaine, gr. \ (0.015), alone or combined 
with bismuth, to control vomiting, 670 

Cold compresses or an ice-bag applied to 
epigastrium in hsematemesis, 670 

Counterirritation, continuous over belly, 
to relieve pain, 669 

Creosote or carbolic acid, for vomiting, 669 

Diet and hygiene, 668 

Hypodermoclysis, 668 

Massage and electricity, 669 

Monsel's solution, cold compresses, adrena- 
lin chloride, or turpentine, may be given 
to check hsematemesis, 670 

Morphine for pain or collapse following 
perforation, 670 

Oil of turpentine one of the best remedies, 
for hsematemesis, 670 

Rectal alimentation, of great service, 668 

Resorcinol useful in some cases, 399 

Rest for the patient and rest for the stom- 
ach essential, 668 

Silver nitrate with hyoscyamus in pill, half 
to one hour before meals, 275, 342, 669 



Spice plaster, useful as a continuous coun- 
terirritant, 669 

Stimulants, cardiac, guardedly adminis- 
tered, external heat and rubbing, in col- 
lapse, following hemorrhage or perfora- 
tion, 670 

GASTRITIS (ACUTE), 670 

Belladonna or atropine, internally, and 
flaxseed poultice over epigastrium and 
chest, if collapse threatens, 670 

Bismuth, as an astringent and sedative, 
121 

Flaxseed tea, a useful demulcent, 252 

Mucilaginous drinks and albuminous sub- 
stances freely given, 670 

Oils, to prevent spread of inflammation, 
670 

Opium, in fluid form, to relieve pain and 
irritation. 670 

Paregoric contraindicated, 670 

Warm water, internally, or stomach-pump, 
to unload stomach at onset, 670 

GASTRO-ENTERITIS, 671 

Castor oil or magnesium sulphate, to sweep 
out poison, 671 

Morphine, hypodermic ally, to allay pain, 
followed or preceded by mild, rapidly 
acting emetic, if irritating substance re- 
mains, 671 

Opium, with hot applications or plasters 
to belly, to control irritation and diar- 
rhoea, 671 

Predigested food, 671 

GASTRO-INTESTINAL CATARRH. 

Ammonium chloride useful in subacute 

types in children, 82 
Carlsbad, Vichy, or other alkaline mineral 

water of purgative powers, often useful, 

531 
Diet for seven-year-old child, 549 
Garlic, as a poultice to belly almost equal 

to spice poultice, 71 
Gentian with bicarbonate of sodium useful 

in children, 257 
Hydrastis, especially useful if due to alco- 
holism, 269 
Salicylate of bismuth in the presence of 

fermentation or putrefaction, 121 
Sanguinaria, of service if jaundice is 

present, 411 
Sodium bicarbonate, 10 to 20 grains, 421 
Tar, in 2-gr. (0.12) pills, 440 
Tartar emetic in acute forms, 88 

GIDDINESS. 

Cod-liver oil with quinine, valuable in old 

age, 209 
Ergot and bromides useful, 236 

GLANDS (DISEASED). 

Ammoniac plaster, as a stimulant to en- 
larged gland, 79 

Ammonium iodide and glycerin (gr. 30 to 
the ounce [2.0:30.0]), locally applied to 
enlarged tonsils, 82 



884 



INDEX OF DISEASES AND REMEDIES. 



Cod-liver oil, in lymphatic enlargements, 
208 

Ichthyol ointment, valuable as an inunc- 
tion in lymphatic enlargements, 278 

Iodine, the best remedy for enlargements, 
284 

Mercury ointment as an inunction in en- 
larged glands, 331 

Phenol (2 per cent, solution), injected into 
glands threatening suppuration, 154 

Potassium iodide for enlargements of the 
cervical glands, 281 

GLAUCOMA, 671 

Atropine, contraindicated, 672 

Eserine (gr. 1 to 2 to the ounce [0.06-0.12 : 
30.0]), or pilocarpine nitrate (gr. 2 to 4 
to the ounce [0.12-0.25:30.0]), dropped 
into eye if operation is delayed, 386, 672 

Hot compresses, leeches, and opiates to 
relieve pain, 672 

Iridectomy, the only curative treatment, 
672 

Pilocarpine in, 389, 672 

GLEET. 

Bichloride of mercury, injection (gr. ^ to 
water 6 ounces [0.03 :180.0]), every three 
or four hours, 326 

Cantharidal collodion, applied to under 
surface of penis or perineum, 492 

Cantharis, 148 

Sandalwood oil, 411 

Turpentine, internally, 451 

Uva ursi, 452 

GOITRE. (See Bronchocele.) 

GONORRHOEA (ACUTE). 672 

Aconite, TT\ 6 (0.4), every two or three 
hours, if inflammation is high, 62, 675 

Almond emulsion, diminishes burning on 
urination, 72 

Argvrol, 1 to 10 per cent., as injection, 
676 

Benzoic acid, with cannabis indica, useful 
in later stages, 119 

Bicarbonate of sodium or potassium citrate, 
gr. 10 (0.60), after meals, increasing, if 
necessary; relieves ardor urinse, 674 

Cannabis indica, often used in later stages 
instead of copaiba and cubebs, 146 

Cinnamon oil, by injection or spray, 197 

Cocaine, solution (4 per cent.), instilled 
into urethra before urination, dimin- 
ishes ardor urinse, 674 

Copaiba and cubebs, useful, 216, 222, 674 

Diet and hygiene, 675 

Erigeron oil, occasionally used instead of 
copaiba and cubebs, 237 

Eucalyptus, valuable in subacute stages, 
249 

Hot bath, prolonged, before going to bed, 
674 

Hydrastis, one of the best remedies, locally 
and internally, in later stages; also as 
a vaginal wash for females, 270, 673 

Lead acetate, injection, gr. 1 to 8 to the 
ounce (0.06-0.5:30.0), 307 



Lead-water and laudanum, or alcohol and 
water, applied on a cloth to penis, dur- 
ing inflammation, 673 

Mercurol, 317 

Mercury bichloride (1 :20,000 or 1 :40,000), 
in large quantities to flush urethra; in 
females, 2 pints of solution (1:4000), 
thrice daily, to irrigate vagina, 672, 680 

Nargol, argyrol, or protargol injections, 
1 to 10 per cent., 340, 676 

Opium or belladonna, hypodermically or in 
suppository, to control pain in posterior 
urethritis, at same time discontinuing 
active treatment, and observing strict 
hygiene and diet, 675 

Permanganate of potassium solution (1 : 
6000), as an antiseptic, 672 

Prescription for administration of balsams, 
673 

Prescriptions for checking the discharge, 
673 

Protargol, 396, 676 

Quercus, injections, useful in females, 398 

Salol (phenyl salicylate), 410, 674 

Sandalwood oil, 674 

Silver nitrate, injections (gr. -h to 3 ounces 
[0.03-90.0]), useful in subacute stage; 
in females, gr. 4 to 40 to the ounce (0.25- 
2.6:30.0), painted over vagina, followed 
by astringent cotton tampon, 343, 680 

Urinating with penis in hot water, to re- 
lieve ardor urinee, 674 

Warm baths, lasting one-half to two hours, 
useful in early stage, 675 

Zinc acetate, injection, gr. 1 to 20 to the 
ounce (0.06-1.3:30.0) of rose-water, 458 

Zinc chloride, injection, gr. 1 to 2 to the 
ounce (0.06-0.12:30.0), occasionally used 
in second stage, 459 

Zinc sozoiodol, 2 per cent, solution, 424 

Zinc sulphate, weak solution, as an astrin- 
gent, 459 

GONORRHOEA (CHRONIC), 676 

Bichloride of mercury useful in, 326 

Copper sulphate or silver nitrate, solution, 
as an application, after dilatation, to 
focus of inflammation, 676 

Dilatation, if stricture exists, 676 

Irrigations daily with nargol, argyrol or 
protargol (1:3000-1:500), silver nivrate 
(1 : 1000), mercurol (1 : 2000) or potassium 
permanganate (1 : 2000-1 : 500), 676 

Prescriptions for, 676, 677 

Pressure and use of cold, often valuable, 
677 

Sandalwood oil, to stimulate depraved 
mucous membrane, 411 

Silver nitrate, solution, if discharge per- 
sists after dilatation; also in posterior 
urethritis, 677 

Unna's treatment with coated sounds, pre- 
scription for. 676 

Uva ursi, 452 

GOUT, 681 

Antipyrin, said to have a specific effect, 93 

Chloral, in insomnia, 682 

Chloroform liniment, applied over affected 
part, 183 



INDEX OF DISEASES AND REMEDIES. 



885 



Cod-liver oil, 209, 682 

Colchicum, wine of seed, TT[ 30 (2.0), in- 
creasing by TT[ 1 (0.05) every four hours, 
until symptoms are relieved or appear 
toxic, in acute types, 210, 681 

Collodion, not more than one or two coats ; 
also useful with iodine, 212, 682 

Diet, 682 

Fowler's solution, ttl 3 (0.20), in water, a 
standard remedy in subacute and chronic 
types, 682 

Gentian, 257 

Guaiac recommended as preventive, 262 

Hot air, valuable, 511 

Iodide of iron, syrup of, and cod-liver oil 
if anremia is present, 682 

Iodide of potassium, to relieve night pains ; 
also with colchicum, in chronic gout, 682 

Iodine, ointment or tincture, locally ap- 
plied to chronic gouty joints, 683 

Leeches or venesection, contraindicated, 
682 

Lithium carbonate or citrate (gr. 5 to 10 
to the ounce [0.30-0.60:30.0]), locally 
applied, to dissolve deposit around 
joints, 311, 682 

Morphine, hypodermically, to relieve acute 
pain, 681 

Peppermint oil, locally applied, 682 

Potassium bromide, the best remedy for 
insomnia, 682 

Potassium permanganate, 377 

Salicylates in large dose may be useful in, 
405 

Sodium bicarbonate and linseed oil (1:9), 
locally applied to joints, 682 

Stimulants, ether hypodermically, opium 
except in brain or kidney disturbances ; 
diuretic and alkaline drinks and counter- 
irritation, in retrocedent gout, 683 

Water, distilled or medicinal, in large 
amounts, 681 

GRANULAR LIDS. (See Conjunctivitis, 
Granular.) 

GRAVE S?S DISEASE. (See Exophthal- 
mic Goitre.) 

GRIPING. 

Allspice or ginger, to prevent griping of 

purgatives, 72, 258 
Belladonna useful, 116 

GROWTHS (PATHOLOGICAL). 

Acid nitrate of mercury, 332 

Caustic potash, or soda, occasionally used 

to destroy, 159 
Chromium anioxide, as a caustic, to 

destroy growths on skin or mucous 

membranes, 188 
Lime as an escharotic on hairy growths, 140 
Methylene blue, 335 
Nitric acid, 344 
Pyoktanin, 334 
Sodium ethylate to remove hairy growths, 

422 
Thiosinamine has been used with some 

success in malignant growths, 444 



GUMS (DISEASES OF). 

Burnt alum, useful if applied to swollen 
gums, 76 

Cocaine, locally applied, in soreness and 
tenderness of gums, 201 

Gambir, as a mouth-wash, for spongy gums, 
255 

Iodine, solution (gr. 1 to the ounce [0.06: 
30.0]), locally applied, followed by rins- 
ing mouth, when gums are retracted, 
285 

Myrrh, tincture, locally applied, to spongy 
or tender gums, 338 

HAY FEVER. 

Adrenalin, locally, to relieve engorgement, 

436 
Arsenic, 103 
Cocaine, with bismuth and morphine, as a 

snuff, 202 
Resorcinol, solution, 2 per cent., in spray, 

399 
Terpine hydrate, in full dose, 442 

HEADACHE, 683 

Acetanilid, 57 

Belladonna, valuable in young people, 118 

Bleeding, 684 

Caffeine, with antipyrin or sodium bro- 
mide, in nervous headache, 136, 684 

Camphor, with acetanilid or antipyrin, in 
nervous headache, 142 

Cannabis indica, when at menopause ' or 
due to retinal asthenopia, 146 

Capsicum plaster to nape of neck, 150 

Castor oil, daily, in neuralgic headache, 156 

Cimicifuga, if due to eye-strain, 189 

Colchicum, in gouty headache, 685 

Croton chloral, if due to eye-strain or asso- 
ciated with sick stomach, 221 

Cup, to nape of neck, in congestion, 684 

Ergot, if due to congestion, 236, 683 

Eucalyptus, if headache be rheumatic or 
malarial, 249 

Gelsemium, if due to nervous troubles or 
eye-strain, 256 

Horseback exercise and sleep very useful 
in obtaining relief from nervous head- 
ache, 685 

Hydrobromic acid, if due to eye-strain in 
nervous women, 131 

Ice-bag, applied to head, or leeches behind 
ears, in severe cases, 684 

Kola, very useful in elixir or tincture for 
sick and neuralgic headaches, 303 

Liquor magnesii citratis, in sick headache, 
314 

Magnesium carbonate, gr. 5 to 60 (0.3-4.0), 
in sick headache due to gastric acidity, 
314 

Mustard foot-bath and plaster to nape of 
neck, in congestion, 337, 684 

Nux vomica, gtt. 1 (0.05), every five or ten 
minutes till 10 minims (0.60) are taken, 
in sick headache, 354 

Phenacetin, if due to eye-strain or neural- 
gia, 379 

Potassium bromide, 127 

Prescriptions for, 684, 685 



886 



INDEX OF DISEASES AND REMEDIES. 



Salicylic acid or iodide or acetate of potas- 
sium, if due to gout, 685 

Sodium bicarbonate, as an anticid in sick 
headache, 421 

Strychnine or mix vomica, in sick head- 
aches or if due to eye-strain, 354, 684 

HEART DISEASE, 685 

Aconite or veratrum, often useful in pal- 
pitation and hypertrophy, 62, 690, 691 

Adonidin, often of service when digitalis 
fails, 63, 689 

Adrenalin intravenously in cardiac and 
vasomotor failure, 436 

Alcohol in heart failure due to shock or to 
poisons, 66 

Ammonia and ether, followed by digitalis, 
and alcohol, in heart failure, 78, 690 

Amyl nitrite, in single whiffs, often relieves 
cardiac failure, 84 

Barium chloride, in heart failure, 112 

Baths bv Schott's method; formula for 
693, 694 

Belladonna, when arhythmia is present 
690; in palpitation, 115; plaster in hyper- 
trophy, 691 

Cactus grandiflora, useful in valvular dis- 
ease with incompetency, cardiac weak- 
ness and palpitation, 134, 690 

Caffeine, very useful, 136 

Camphor in palpitation, 142 

Cimicifuga, as a tonic in fatty and irritable 
heart when digitalis fails, 189 

Citrate or bitartrate of potassium with 
digitalis when secretion of urine is 
scanty, 690 

Convallaria majalis, in cardiac arhythmia, 
215 

Diet, exercise, and hygiene, 691 

Digestive remedies, in palpitation due to 
indigestion, 690 

Digitalis, to be tried in all heart troubles, 
except in simple or compensatory hyper- 
trophy, 228, 687 

Hoffmann's anodyne, very useful in palpi- 
tation due to indigestion or tobacco, 
266 

Hydragogue cathartics for the dropsy and 
portal engorgement, 690 

Iodides to relieve tension in fatty heart, 
692 

Iron, arsenic, and simple bitters for asso- 
ciated debility and anosmia, 689 

Iron in palpitation due to anaemia, 690 

Kola, useful in cases with debility, 303 

Nitroglycerin, when arterial tension is high, 
690 

Nux vomica, as a stimulant, 690 

Opium, if dyspnoea prevents sleep, 364 

Potassium bitartrate or citrate with digi- 
talis for scanty secretion of urine, 690 

Rest in bed essential when aconite is used, 
691, 692 

Sparteine, in arhythmia or palpitation, also 
as a substitute for digitalis, if it fails, 416, 
690 

Strophanthus, if digitalis fails, 429, 689, 
690 

Suprarenal gland, in heart failure due to 
lack of vascular tone, 436 



Venesection followed by digitalis for over- 
distended right ventricle, 689 
Veratrum, 456, 691 

HffiMATEMESIS, 698 

Adrenalin, 698 

Ergot, hamamelis, or ipecac, in slow bleed- 
ing, 699 

Hamamelis, internally, 265 

Ice, cracked, swallowed frequently, accom- 
panied by Monsel's solution, XT[ 3 (0.20), 
in a half-tumblerful of water, every fif- 
teen minutes, 698 

Iron, tincture of chloride, or turpentine, 
internally, 699 

Lead acetate with morphine or opium, gr. 
2 to 3 (0.12-0.20), in pill, 698 

Monsel's salt, gr. 2 to 3 (0.12-0.20), in pill, 
298, 698 

Silver nitrate, gr. ^ (0.015) in pill, in slow 
bleeding, 699 

Tannic acid, gr. 20 (1.3) to drachm (4.0); 
must not be given with Monsel's solu- 
tion, 698 

HEMATURIA, 700 

Adrenalin chloride (1 :5000) as injection, 

701 
Alum, gr. 2 to 3 (0.12-0.20) to water 1 ounce 

(30.0), injected into bladder, if alarming, 

701 
Astringent injections, should be used only 

when bleeding is alarming, 701 
Camphor, gr. 10 to 20 (0.6-1.3), in divided 

doses, in pill, 701 
Cannabis indica, useful in some cases, 

701 
Ergot, 701 
Erigeron, 701 
Gallic acid, gr. 20 (1.3), very valuable, 254, 

701 
Hamamelis, injected daily into bladder, or 

used internally, 265 
Hyposulphite of sodium, 5 to 15 gr. (0.3- 

1.0), if due to malaria, 423, 701 
Morphine and atropine hypodermically and 

cups over kidneys in hematuria, 701 
Prescriptions for, 701 
Quinine, usually harmful, unless due to 

malaria, 701 
Rhus aromatica, 401 
Turpentine, 451, 701 

HEMOPHILIA. 

Calcium chloride, 138 

HEMOPTYSIS, 697 

Acetanilid, has been recommended, 57 

Aconite, to prevent pneumonia following, 
contraindicated in exhaustion, 698 

Alum, solution (gr. 20 to the ounce [1.3: 
30]), in fine spray, 76 

Chloral and bromides, to allay nervous ex- 
citement, 698 

Ergot, fluid extract, 1 to 1% drachms (4.0- 
6.0), internally, 697 

Esmarch bandages to limbs when aconite 
cannot be used because of exsanguina- 
tion, 698 



INDEX OF DISEASES AND REMEDIES. 



887 



Gallic acid, gr. 20 to the ounce (1.3:30.0) 
of water, when ergot is not at hand, 254, 
697 

Hamamelis, 265 

Ice or dry cup over bleeding spot, 698 

Ice or ice-cold compresses to the scrotum 
or vulva in, 698 

Ipecac, in small doses, very effective, 291 

Morphine, hypodermically, to allay ner- 
vousness and cough, 362, 698 

Tannic acid, Monsel's solution, or alum, 
used in spray, as stvptics, prescriptions 
for, 297, 439, 679 

HEMORRHAGE, 695 

Alum, a useful styptic, applied to bleeding 
vessel, 75 

Antipyrin, 94 

Arnica, 99 

Cinnamon in uterine hemorrhage, 197 

Compress, soaked in antiseptic liquid or 
filled with antiseptic powder, preferable 
to styptics, 695 

Gelatin, locally and hypodermically, to aid 
in the coagulation of blood, 696 

Hamamelis, useful for uterine oozing, and 
bleeding from the bladder, 265 

Hypodermoclysis, 512, 513, 695 

Ligation preferable to styptics, when appli- 
cable, 695 

Monsel's solution, 297 

Oil of erigeron, 237 

Packing of astringents, if bleeding point 
cannot be reached by compression, or 
for ligation, 695 

Sulphate of sodium, by the mouth or intra- 
venously; useless hypodermically, 423 

Tannic acid, 439 

Transfusion, 538, 696 

HEMORRHAGE (INTESTINAL), 699. 
(See also Hemorrhage.) 

Chloride of calcium, 699 

Enemas, styptic, for hemorrhage from 
rectum or colon; adrenalin chloride, 2 
drachms of 1 :1000 solution in \ pint of 
normal salt solution; alum (gr. 10 to the 
ounce [0.60:30.0]), copper (gr. 5 to the 
ounce [0.3:30.0]), Monsel's solution (dr. 
| to 2 ounces [2.0:60.0]), Monsel's salt 
(gr. 10 to the ounce [0.60:30.0]), or 
drachm ^[2.0] to water 2 ounces [60.0]), 
chlorate of potassium (gr. 10 to 25 to 
the ounce [0.6-1.6:30.0]), tannic acid 
(gr. 20 to ounce [1.3:30.0]), of glycerin 
and water, 699, 700 

Ergot, 235, 699 

Ice, by mouth, and to the belly, and Mon- 
sel's salt, gr. 3 (0.20), in hard pill, every 
half-hour or oftener, 699 

Ice-water injections in bloody purging of 
dysentery, 700 

Lead acetate and camphor, in pill, of ser- 
vice in some cases, 699 

Monsel's solution not advisable, 298 

Sulphuric acid, gtt. 5 to 10 (0.3-0.60) in 
water, 699 

Tannic acid, when Monsel's salt is not at 
hand, 699 



Turpentine, in capsule or emulsion, when 
bleeding is not active, 451, 699 

HEMORRHOIDS, 702 

Aloes, 74 

Antipyrin with cocaine in suppository, to 
check bleeding and relieve pain, 94 

Carbolic acid injection dangerous, 703 

Cocaine and iodoform ointment, prescrip- 
tion for, 703 

Cold-water injections in the morning, re- 
lieve congestion and cause easy evacua- 
tion, 475, 703 

Ergot, sometimes useful in bleeding piles, 
236 

Gallic acid and ointment of stramonium, 
equal parts, 254 

Gallic acid and opium suppository, pre- 
scription for, 702 

Hamamelis, internally or as a lotion or in- 
jection, 265, 702 

Hot compress wet with adrenalin chloride, 
1 :2000, 703 

Hygiene and general rules, 703 

Iodoform suppository, if ulceration is 
present, 289 

Lead-water and laudanum lotion after 
acute stage is passed, 703 

Linseed oil, 252 

Nitric acid, lightly touched to one or two 
points; as a lotion, \ to 1 drachm to the 
pint of water in bleeding hemorrhoids, 
345, 702 

Potassium chlorate, with laudanum, as an 
injection, 168 

Quercus, as an astringent wash, 398 

Stillingia, prescription for, 427 

Sulphur, to produce soft passages, 432 

Tannic acid, suppositories in bleeding piles, 
439 

HEPATIC ABSCESS, 704 

Active treatment for dysenterv, if present, 

704 
Ammonium muriate, thought to be of 

value, 82 
Aspiration, when pus forms, 704 
Diet, 704 
Quinine and iron, after abscess develops, 

705 

HEPATIC CIRRHOSIS. 
Ammonium chloride, 82 
Iodoform, highly recommended, 288 
Liver, 3 oz. of fresh gland, in delirium of 

cirrhosis, and in alcoholic cirrhosis with 

icterus, 279 
Nitro-muriatic acid, in early stages, 348 
Potassium iodide, often useful in early 

stages, 280 
Sodium phosphate very useful, 381 

HEPATIC TORPOR. 

Ammonium chloride in, 82 

Chirata, in indigestion due to torpor, 161 

Citric acid in, 198 

Euonymus in, 250 

Nitro-hydrochloric acid when either acute 

or chronic, 348 
Taraxacum, 441 



888 



INDEX OF DISEASES AND REMEDIES. 



HEPATITIS (ACUTE), 704 

Cantharidal blister, small, over right hypo- 
chondrium; if impracticable, use mustard 
plaster, 704 

Hot cloths, over counterirritant, may re- 
lieve pain and aid in formation of blister, 
704 

Saline purgatives, preceded by calomel, 
gr. 1 (0.06), in divided doses, if constipa- 
tion exists, 704 

Sweet spirit of nitre with potassium citrate, 
or diuretic waters, to regulate kidneys, 
704 

Veratrum, 456 

HEPATITIS (CHRONIC AND SUB- 
ACUTE), 705 

Ammonium chloride, useful in subacute 
forms, 82 

Antisyphilitic treatment, if due to syphilis, 
705 

Aspiration, frequently repeated, may effect 
a cure, 705 

Nitro-muriatic acid, internally and exter- 
nally, most useful remedy, 348, 705 

Potassium iodide, useful in all cases, 705 

HERNIA. 

Chloroform or ether inhalations, to relax 
muscles during reduction, 179, 243 

HERPES. 

Anthrarobin in, 85 

HICCOUGH, 705 

Amyl nitrite, 706 

Belladonna, 116 

Camphor, spirit of, dose 1 drachm (4.0), 
142, 705 

Capsicum, tincture, \T[ 2 to 3 (0.1-0.20), 
705 

Chloral, 166 

Chloroform, 705 

Emetics or purges when gastric or intestinal 
irritation is present, 705 

Ether, sprayed on epigastrium, 243, 706 

Hoffmann's anodyne, especially valuable, 
266, 705 

Hot pack when due to uraemia, 706 

Musk, gr. 10 (0.60), given by rectum, valu- 
able in all cases, especially in typhoid 
fever, 337, 706 

Nux vomica, accompanied by mineral 
acids, if due to indigestion, 706 

Oil of amber, Til 5 to 10 (0.3-0.60), in cap- 
sule, one of the best remedies, 76, 706 

Sodium bromide and laudanum by the 
bowel when life is threatened, 706 

Valerian, tincture of, dose 1 drachm (4.0). 
705 

HYDROCELE. 

Iodine, injections, after evacuation of the 
sac, the best curative remedy, 285 

HYDROCEPHALUS. 

Potassium iodide, to cause absorption of 
fluids, 280 



HYSTERIA. 

Calcium bromide, 130 

Hops, as a nervous sedative, 269 

Monobromated camphor, to produce sleep, 

144 
Oil of amber, 77 

Ovarian extract has been used, 259 
"Pill of three valerianates," recommended, 

453 
Potassium bromide, 127 
Valerian, 453 
Valerate of ammonium, 83 
Valerate of iron, if associated with anaemia, 

299 

IMPOTENCE. 
Cannabis indica, with strychnine, nux 

vomica, or ergot, if no organic trouble 

exists, prescription for, 146 
Cantharis, with nux vomica and iron, may 

restore sexual power if loss is due to ex- 
cess, 148 
Cold douche to perineum and testicles, in 

atonic types, 476 
Gold, chloride of, and sodium, gr. J*- (0.003), 

261 

INCONTINENCE OF URINE, 706 

Alkalies, 706 

Ammonium benzoate or urotropin, gr. 4 
(0.25), in water, three times a day, if 
urine is concentrated and ammoniacal 
in odor, 707 

Antiseptic fluids, to cleanse bladder, in 
paralysis, 708 

Arsenic, with nux vomica, in weakness of 
spinal centres, prescription for, 707 

Belladonna, if due to vesical spasm, 116, 
707 

Bromides with chloral, if due to vesical 
spasm, 127 

Buchu, with sweet spirit of nitre, valuable 
in some cases, 133 

Cantharides, TT1 \ (0.025), with alkaline 
diuretics, thrice daily, in adults, 148, 708 

Catheterization, in retention or paralvsis, 
708 

Circumcision, if prepuce is redundant, re- 
lieves some Cases, 706 

Fowler's solution, T7] \ to 1 (0.025-0.05), 
in chronic types due to atony, 707 

Hyoscyamus, if due to irritable bladder,275 

Potassium citrate when due to acidity, 395 

Rhus aromatica, in incontinence of chil- 
dren, due to atony, 401 

Santonin, often valuable when other rem- 
edies fail, 412 

Strychnine, 707 

Sweet spirit of nitre and potassium citrate, 
if urine is dark and concentrated, pre- 
scription for, 437, 707 

Worms removed from vagina often cure, 
706 

INDIGESTION (GASTRIC AND INTES- 
TINAL), 708 

Alkalies, before meals in atonic states, dur- 
ing or after meals when the secretion of 
acid is excessive, 709, 710 



INDEX OF DISEASES AND REMEDIES. 



889 



Ammonium acetate solution as an antacid 
in gastric indigestion, 80 

Ammonium chloride, in painful forms, 82 

Asafcetida, in indigestion of old age, asso- 
ciated with flatulence, 110, 713 

Bicarbonate of sodium with bitters, 709 

Bitter tonics, Useful in atony, contraindi- 
cated in gastric irritation, 709 

Bromide of strontium, in excessive secre- 
tion, when not due to ulcer, 428, 711 

Bryonia, when dependent upon gastric or 
intestinal atony, 132 

Carbolic acid and bismuth, 711 

Chirata, if liver is torpid or constipation is 
present, 161 

Chloral, creosote sodium hyposulphite, or 
thymol, with lavage, when fermentation 
is excessive, 712 

Chloroform spirit, TTl xx (1.3), often of 
great value, 713 

Creosote, HI $ to 2 (0.025-0.1) after meals 
in fermentation, due to deficient diges- 
tion of meats or the use of sweets, 221 

Diastase when starchy foods are not di- 
gested, 224 

Diet, 709 

Fats, excluded in fermentative types, 712 

Gold, chloride of, and sodium, when epi- 
gastric pain is present, 261 

Hydrochloric acid, combined with carda- 
moms, in atrophy of the gastric tubules, 
cancer, or intestinal dyspepsia, 270, 710 

Hyoscyamus, belladonna, opium, bromides, 
bismuth, when there is hyperacidity, 710 

Lavage, 712 

Leptandra, of great value in intestinal 
types, prescription for, 309 

Massage, 713 

Nitrate of silver, especially where an ulcer 
is present, 711 

Nitro-hydrochloric acid or nitric acid, 
valuable in many cases, 345, 348, 713 

Ox-gall, 368 

Pancreatin, with sodium bicarbonate and 
alkaline mineral waters, in intestinal 
types, 712 

Papain, 372 

Pepsin immediately after meals, 377 

Podophyllin or mercury in lientery, 713 

Prescription for flatulence of intestinal in- 
digestion, 712, 713 

Prescription for torpid liver of indigestion, 
713 

Rhubarb, quinine, condurango, and nux 
vomica, useful tonics, 710 

Salol (phenyl salicylate) in intestinal form 
with fermentation, 410 

Serpentaria as a tonic, 418 

Test-meal as a means of diagnosis, 709 

Thymol, beta-naphthol, creosote, chloral, 
and sodium thiosulphate in acidity due 
to acids of fermentation, 712 

Yellow oxide of mercury, gr. fa to fa 
(0.001-0.0012), in trituration, if there 
is foul belching or ill-smelling stools, 332 

INFLAMMATION. 

Aconite, in acute, 62 

Bismuth in inflammation of mucous mem- 
branes, 120 



Cannabis indica, valuable in chronic tvpes, 

146 
Cocaine, in acute types, prescription for, 201 
Cold applications, locally, 471 
Flaxseed for inflamed mucous membranes, 

252 
Hop poultice, 269 
liquor plumbi subacetatis, useful as a 

topical application, 307 
Opium, 362 
Silver nitrate useful in all inflammations 

of the pharynx, larynx, fauces, and 

mouth, 343 
Sulphurated lime, useful to check, 141 
Tartar emetic, in sthenic inflammation, 88 
Turpentine stupe, 450 
Veratrum, 456 

INFLUENZA, 713 

Aconite, sweet spirit of nitre, and citrate 
of potassium in combination, valuable 
in early stage, 715 

Alcohol, 717 

Antipyrin, phenacetin, and acetanilid 
should be used only in small doses to 
allay pain, 714 

Belladonna, combined with strychnine, if 
there be vasomotor paresis, 717 

Bromides, codeine or morphine, if cough 
be excessive, 717 

Cannabis indica, often valuable, if pushed, 
for irritative cough, 718 

Castor oil or magnesium sulphate for con- 
stipation, 718 

Chloral, chioralformamide, or sulphonal, 
for insomnia, 718 

Cold bath, preferable to antipyretics for 
reduction of temperature, 715 

Cups, contraindicated, 716 

Ergot, cannabis indica, with bromides, 
often relieve vertigo, 718 

Monobromated camphor, 144 

Phenacetin, 380 

Remedies for bronchitis when present, 717 

Salicin, 403 

Salol (phenyl salicylate) and phenacetin, 
valuable in combination, to allay irrita- 
tion and pain, 714 

Sandalwood oil, for excessive cough, 411 

Steam inhalations, laden with vaporized 
drugs, for cough, 717 

Strychnine preferable to digitalis, if there 
be tendency to collapse, 716 

INSANITY. (See Mania, Acute.) 

INSOMNIA, 718 

Amylene hydrate, useless if due to pain, 
720 

Bath, cold, in cerebral anaemia, hot, in 
nervous irritability, 474 

Bromide of potassium with Fowler's solu- 
tion, in nervous females, prescription for, 
719 

Chloral, useful if not due to pain, prescrip- 
tion for, 164, 718 

Chioralformamide, gr. 15 to 60 (1.0-4.0), 
in wine or capsule, in nervous insomnia, 
165, 720 



890 



INDEX OF DISEASES AND REMEDIES. 



Chloralose, 2 to 8 grains (0.12-0.5), in cap- 
sule, 167 

Chloretone, 168, 720 

Chlorobrom for insomnia of melancholia 
and acute mania, 166 

Croton chloral preferable to chloral, if due 
to pain, 221 

Duboisine more useful than hyoscine, 232 

Hop pillow, 269 

Hot pack in nervous insomnia, 509 

Hot-water bags to feet and cold to head, 
or general hot bath, 719 

Hyoscine gr. T ^ to ^ (0.0006-0.0007), bv 
mouth, or gr. ^ to ^ (0.0004-0.0006), 
hypodermicallv, in mania or hysteria, 

276, 719 

Hypnal, useful in insomnia due to pain, 

277, 720 

Morphine with chloral, if due to pain, pre- 
scription for, 719 

Opium, only to be used in pain, 361 

Paraldehyde, 373, 720 

Potassium bromide, in nervousness and 
overwork, 128 

Somnal, minims 10 to 40 (0.60-2.6), in 
liquorice and water, 424, 720 

Sulphonal, prescription for, may be given 
in hot water, 431, 720 

Trional, in 15-grain (1.0) doses, 449, 720 

Valerian, in nervousness, 453 

INTERMITTENT FEVER, 721 

Alcohol, contraindicated during chill, 722 

Ammonium chloride in, 82 

Anesthetization, has been employed to put 
off paroxysm, 723 

Arsenic, in intervals between attacks, as 
an antiperiodic, 102 

Calomel, gr. i to i (0.01-0.015), every fif- 
teen minutes until 1 grain (0.06) is taken, 
four or five hours before quinine, if con- 
stipation is present, 722 

Chloroform inhalations, preceded by lauda- 
num, by mouth or rectum, or morphine, 
gr. i (0.01), with atropine, gr. 6 \ (0.001), 
hypodermicallv, if death threatens dur- 
ing chill, 723 

Cool drinks and sponging, in fevered stage, 
cold with friction, 723 

Digitalis or strychnine, to relieve internal 
congestion during chill, 722 

Eupatorium useful in, 250 

Ipecac or zinc sulphate, as an emetic, if 
chill follows full meal, 722 

Methylene blue, 1 to 4 grains (0.06-0.25), 
335, 723 

Podophyllin, gr. ^ to J (0.006-0.008), pre- 
ceding quinine, if constipation is present, 
722 

Potassium or sodium nitrite, gr. 10 (0.60), 
has been employed to put off attack, 723 

Quinine, as a prophylactic and antiperiodic, 
721 

INTERTRIGO. (See Chapping.) 

INTESTINAL CATARRH. 

Ammonium chloride, useful in subacute 
types, 82 



Chlorate of potassium, injections (gr. 20 to 

the ounce [1.3:30.0]), in acute rectal 

catarrh, 168 
Iodide of potassium, if ammonium chloride 

fails to relieve, 280 
Leptandra, fluid extract, dose 20 minims 

to 1 drachm (1.3-4.0), 309 
Salol, 410 

INVOLUTION (ANOMALIES OF), 769 

Applications of nitric acid and silver nitrate 
useful in lacerations, 770 

Cannabis indica, of great value in subinvo- 
lution, 146 

Cimicifuga in subinvolution, 189 

Curette in subinvolution due to retention 
of hypertrophic endometrium, 769 

Digitalis in subinvolution due to smggish 
circulation, 770 

Ergotin, gr. j, hydrastinin, gr. \, and 
stypticin, gr. j, in pill, if due to fibroids, 
235, 769 

Mammary gland, 315 

Purgatives, disinfectants, and possibly hot 
water locally applied, if due to inflam- 
mation, 770. 

Removal of placenta, if adherent, 770 

IRITIS, 723 

Atropine, the best local remedy, 117, 723 

Daturine, scopolamine, or duboisine, when 
atropine cannot be used, 723 

Dionin, 1 per cent, solution, locally, for 
pain, 724 

Holocaine as a local anaesthetic, 267 

Hyoscine valuable for pain, 724 

Iced compress, in early stage of traumatic 
iritis, 723 

Iodide of potassium, alone or with mercury 
bichloride, following mercurial impres- 
sion, in syphilitics, 723 

Iridectomy required in some cases, 724 

Leeches and dry heat or hot fomentations, 
to relieve pain, 723 

Mercury, preferably by inunction, if due 
to syphilis, 724 

Morphine, if pain is severe, 724 

Paracentesis, 724 

Pilocarpine, internally if vitreous becomes 
opaque, also in gonorrhceal types, 724 

Salicylic acid or oil of gaultheria, followed 
later bv potassium iodide, in rheumatic 
iritis, 724 

Saline laxatives, during course of disease, 
followed by iron, after cessation of spe- 
cific treatment, 724 

Scopolamine in early stages of, and in 
plastic, 414 

Subconjunctival injections of cyanide of 
mercury (1 :5000-l :1000), or of salt solu- 
tion recommended in syphilitic iritis, 724 

Zollicoffer's mixture, useful in chronic 
types, 724 

IRRITABILITY. 

Almonds, as a drink in irritability of in- 
testines and air-passages, 72 

Cantharis, recommended in irritable blad- 
der of women and children, 148 

Cimicifuga, in uterine irritability, 189 



INDEX OF DISEASES AND REMEDIES. 



891 



Hops, in vesical irritability, 269 
Hydrocyanic acid, in irritability of the 

stomach, 272 
Hyoscyamus, for vesical irritability with 

incontinence, 275 
Petrolatum, as a soothing agent in gastro- 
intestinal types, 378 
Piperazine, in bladder irritation due to 

excess of uric acid, 391 
Potassium bromide, in irritability of phar- 
ynx, 127 

JAUNDICE. 
Calomel, gr. £ (0.01), every half-hour till 
gr. ^ (0.03) is taken, if due to cold, 328 
Carbolic acid (phenol), gr. 10 (0.60), with 
water and gtycerin, each 2 drachms (8.0), 
locally applied in itching of jaundice, 
154 
Citric acid, in catarrhal form, 198 
Hydrastis, useful in subacute types, 269 
Iodoform, highly recommended, 288 
Manganese sulphate, may be tried in 

malarial types, 316 
Pilocarpine, useful unless due to malignant 

disease, 389 
Salol, said to be of value, 410 
Sodium phosphate, of value, 381 

JOINTS (ENLARGED). 

Tartar emetic ointment as a counter- 
irritant in old enlargements, 88 
Turpentine liniment, 452 

JOINTS (INFLAMED). 

Alcohol, locally, as a wash, 67 
Camphor liniment, locally, 143 

JOINTS (RHEUMATIC). 

Oil of amber as a counterirritant over, 77 

KELOID. 

Ichthyol ointment, 278 

Thiosinamine, 10 per cent, solution in 
alcohol, injected into the growth, 444 

KERATITIS (INTERSTITIAL), 725 

Antiseptic lotions, in marked ciliary con- 
gestion, 725 

Antisyphilitic treatment, if due to syphilis, 
725 

Atropine, in ciliary congestion, to prevent 
iritis, 725 

Leeches, to temple to relieve pain, if 
patient it not too young for bleeding, 
725 

Thymol iodide, as a dusting-powder, 445 

KERATITIS (PHLYCTENULAR), 725 

Atropine, to relieve pain, 726 

Boric-acid solution, to relieve congestion, 

726 
Cocaine, not advisable in photophobia, 

726 
Cold-water douche on closed eyelid, to 

relieve photophobia, 726 
Creolin solution, 1 to 2 per cent., as a 

wash, 221 
Dark glasses, to protect eyes, 726 



Tonics and alteratives, with strict hygiene 
and regulated diet, associated with local 
treatment, 726 

Yellow oxide of mercury ointment, or 
calomel as a dusting-powder, to hasten 
cicatrization, contraindicated if iodine 
is being given, 726 

KERATITIS (ULCERATIVE), 726 

Antiseptic lotions, to limit sloughing, 727 

Atropine, instilled into eye, to limit slough- 
ing, 727 

Cautery, actual, best means of preventing 
perforation, 727 

Curetting floor of ulcer, if perforation 
threatens, 727 

Eserine, instilled into eye, in peripheral 
ulcers, 727 

Holocain as an anesthetic, 727 

Hot compresses, 727 

Massage of cornea and introduction of 
yellow-oxide ointment to remove scars 
of ulcers, 728 

Pressure bandage, if perforation threatens, 
_727 

Silver nitrate, tincture of iodine, or for- 
maldehyde applied to margin of ulcer 
does good, 727 

Subconjunctival injections of cyanide of 
mercury (1 :5000), or of salt solution to 
absorb corneal nebula, 728 

LACRYMAL ABSCESS, 728 

Division of canaliculi and washing out sac 
with antiseptic fluids, and insertion of 
probes into ducts after inflammation 
subsides, to restore patulency, 728 

Formaldehyde (1 :6000), silver nitrate 
(1:500), or protargol or argyrol (2 to 
5 per 100) injected through external 
opening if there is purulent discharge, 
729 

Hot compresses, composed of lead-water 
and laudanum, to relieve pain, 729 

Puncture of abscess, if rupture threatens, 
728 

LARYNGISMUS STRIDULUS. 

Amyl nitrite, 84 
Belladonna, 116 
Bromide of potassium, 127 
Gelsemium, 257 

LARYNGITIS (ACUTE), 729 
Aconite, to control fever, 730 
Antipyrin, as a spray, 94 
Bromides, useful in full doses, 60 to 120 

grains (4.0-8.0) a day, 127, 730 
Calomel, small and repeated doses, followed 

by saline purges, along with hot mustard 

foot-baths and demulcent drinks, 730 
Creosote spray in subacute laryngitis, 220 
Cubebs cigarettes, useful for hoarseness of 

subacute forms, 222 
Inhalations in, 520 
Iodine, painted over throat, useful on third 

or fourth day, 730 
Mustard plaster or hot applications over 

larynx, 730 



892 



INDEX OF DISEASES AND REMEDIES. 



Nitric acid, dilute, Til 2 or 3 every ^ hour 

or hour for six doses in early stage, 730 
Oil of amber and olive oil, half and half, 

well rubbed into the skin of the neck 

and chest, 77, 730 
Prescriptions for sprays, 729 
Silver nitrate, 343 
Steam inhalations, charged with benzoin ; 

often advantageous to add menthol, 119, 

729 

LEPRA. 
Arsenic, 103 

LEUCOCYTILffiMIA. 

Arsenic, very useful in full ascending 
doses, 101 

LEUCORRH(EA, 730 

Alum, gr. 10 to 20 to the ounce (0.60-1.3: 
30.0), as a vaginal wash, 76 

Ammonio-ferric alum, gr. 2 to 5 (0.12-0.30), 
in atonic types, 294 

Belladonna, gr. 1 to 2 (0.06-0.12), with 
tannic acid, gr. 6 to 8 (0.5), applied on 
cotton, in disease of uterine cervix, 116 

Cantharidal collodion, applied over groins 
to produce blister, 731 

GoodelFs prescription for, 731 

Hffimatoxvlon, used internally, of service, 
264 

Hot sitz-bath, or vaginal injections of hot 
water, if due to uterine congestion, 505 

Hydrastis, injections, 269, 270 

Iron, with tonics, if due to excessive lacta- 
tion or exhausting life, 731 

Myrrh, if due to uterine trouble, 338 

Nitrate of silver, when there is cervical 
ulceration, 343 

Potassium permanganate (drachm \ [2.0] 
to water 1 pint [480.0]), as an injection, 
if discharge is fetid, 732 

Prescriptions for injection, 732 

Ringer's prescription for wash, 732 

Tampon, saturated with iodoform and 
tannic acid, 439, 732 

White-oak bark (ounce 1 [30.0] to water 1 
pint [480.0]), or tannic acid and glycerin 
(ounce 1 [30.0] to 2 quarts [2 litres] of 
water), as an injection, 398, 732 

LICHEN. 

Arsenic, usually cures, 103 
Cantharides, 148 

Carbolic acid (phenol) ointment in lichen 
planus, 154 

LID ABSCESSES, 733 

Treatment same as for other abscesses, 733 

LITRffiMIA. (See Gout.) 

LOCOMOTOR ATAXIA. 

Acetanilid, 57 

Antipyrin, relieves lancinating pains, 93 
Chloralformamide, prescription for, 166 
Co-ordinated movements in, 488 
Exalgine, prescription for, 251 
Phenacetin, 379 



Potassium bromide, to prevent laryngeal 

crises, 127 
Suspension, 536 

LUMBAGO, 733 

Acupuncture, often relieves, especially if 

pain is bilateral, 461, 733 
Antifebrin, dose gr. 2 to 4 (0.12-0.25), 733 
Antipyrin, dose gr. 5 to 10 (0.30-0.60), 733 
Capsicum plaster useful, 150 
Chloroform liniment, 183 
Cod-liver oil, 208 
Foot-bath and Dover's powder, before 

retiring, often relieves, 733 
Hot poultice to back often useful, 733 
Ice-bag or ether spray to loins, if hot 

applications fail, 733 
Ironing back with laundry iron, skin being 

protected by cloth or paper, very 

efficient, 504, 733 
Monobromated camphor, with other drugs, 

very useful, 144 
Mustard or capsicum plaster or blister over 

painful spot may relieve, 733 
Phenacetin and salol, of each 5 grains (0.3), 

733 
Potassium iodide or salicylic acid, if 

recovery is slow, 280, 733 
Salicylic acid, useful, 405, 733 
Turpentine, gtt. 20 (1.3), said to be useful, 

451 

LUPUS. 
Acid nitrate of mercury, 332 
Europhen, in ointment or powder, 251 
Ichthyol ointment, 278 
Iodine, as a paint, to retard spread, 285 
Thiosinamine, useful in, 444 

MALARIAL FEVER. (See Intermittent 
and Remittent Fevers.) 

Antipyrin, 94 

Arsenic, as a cure and prophvlactic, 101 

Calomel, 324 

Eucalyptus, instead of quinine, when it 
cannot be borne, 249 

Gelsemium, of doubtful value, 257 

Gentian, in malaria associated with dys- 
pepsia, 257 

Hydrastis, said to be antimalarial, 270 

Methylene blue, 1 to 4 grains (0.05-0.2), 
335 

Phenocoll, useful in some cases, 380 

Pilocarpine, may be used to abort, 389 

Piperin, has been used with varying 
success, 374 

Quinine, the best remedj^ as a prophylactic 
and a cure, 193 

Warburg's tincture, said to excel quinine 
in pernicious malarial regions, 457 

MANIA (ACUTE), 733 

Anaesthetics, or apormorphine in emetic 
dose, to relax muscular system, if patient 
is very violent, so that other remedies 
may be administered, 734 
Bromide of potassium, as a soporific. 128 
Cannabis indica, with large doses of bro- 
mides, particularly serviceable, 734 



INDEX OF DISEASES AND REMEDIES. 



893 



Chloral, in full doses, if kidneys are 

healthy, 734 
Chloroform for insomnia, 179 
Cimicifuga, fluid extract, TTl 20 to 30 (1.3- 

2.0) thrice daily, in cases occurring after 

confinement not due to permanent 

causes, 733 
Cold douche to head while body is im- 
mersed in hot water, often of service, 

734 
Duboisine, for insomnia, 232 
Hot steam bath or Russian bath valuable, 

734 
Hyoscine hydrobromide, gr. T fo (0.0006), 

when necessary to quiet patient quickly, 

733 
Morphine, in full dose, may be required to 

quiet patient, 734 
Sulphonal as an hypnotic, 431 
Tlryroid gland, gr. 5 to 20 (0.3-1.3), 448 

MARASMUS. 

Cod-liver oil inunctions, one of the best 

remedies, 208 
Mercurv with chalk in svphilitic marasmus, 

330 

MASTITIS. (See Breast, Inflamed.) 

MELANCHOLIA, 734 

Chloroform for insomnia, 179 
Nitro-muriatic acid, YX[ 5 (0.3), in water 

after meals, if associated with oxaluria, 

349, 734 
Phosphorus, useful in some cases due to 

overwork, 384 
Thyroid gland, gr. 5 to 20 (0.3-1.3), 448 



MENINGITIS (ACUTE). 734 

Aconite of veratrum, in early stages 



to 



depress circulation, 734 
Alcohol, given with food in second stage, 

if there be asthenia, 735 
Belladonna, often useful, especially when 

opium and calomel are contraindicated, 

735 
Blister to nape of neck, in early stage to 

prevent effusion; also in comatose state, 

735 
Bromides and chloral, best agents to allay 

nervous symptoms, 735 
Calomel, gr. \ (0.03), with opium, gr. \ 

(0.015), every half-hour, in early stage, 

until effect is manifested; the deodor- 
ized tincture, TTl 2 to 5 (0.1-0.30), every 

two hours, or less, preferable to powder 

of opium in some cases, 735 
Ice-bag to head, in early stage, 474, 735 
Leeches to nape of neck, in early stage, 735 
Lumbar puncture if symptoms of cerebral 

pressure are marked, 735 
Milk diet, in second stage, 735 
Opium, useful in second stage, 361, 362, 

735 
Quinine, contraindicated in acute stage, 

735 
Venesection in early stage of sthenic cases, 

if aconite or veratrum viride is not at 

hand, 540, 735 



MENINGITIS (CHRONIC). 

Phosphorus, 384 

MENOPAUSE. 

Bromide of potassium, in nervous dis- 
orders, 127 

Cannabis indica, alone or with aloes and 
iron, if anaemia or constipation exist in 
headaches of the menopause, 146 

Eau de Cologne, saturated with camphor, 
locally applied in headache or drowsi- 
ness, 143 

Ovarian extract, for nervous and nutri- 
tional disturbances, 259, 367 

Valerate of ammonium, in nervous dis- 
orders, 83 

MENORRHAGIA AND METROR- 
RHAGIA, 696 

Adrenalin chloride (1 :5000) may be em- 
ployed, 436, 696 

Bromide of potassium or sodium, gr. 10 
(0.60) once or twice dailv, if bleeding is 
irregular, 128, 696 

Cannabis indica, recommended, 146, 696 

Cinnamon oil, drachm \ (2.0), when erig- 
eron is not at hand, in oozing flow, 697 

Cotarnine useful, 218 

Dry cups, over sacrum, if due to conges- 
tion, 697 

Ergot, fluid extract, TTl 10 to 60 (0.60-4.0), 
best remedy in active bleeding, 235, 696 

Erigeron, oil of, minims 3 to 5 (0.20-0.3), 
in capsule or emulsion, the best remedy 
for oozing, 696 

Hamamelis, water of, drachm 1 (4.0) thrice 
daily, in irregular bleeding, 696 

Mammary gland, 315 

MonsePs solution (50 por cent.) full strength 
locally applied, if due to polypus, 298 

Rhus aromatica, highly recommended in 
menorrhagia, 401 

Rue, in atonic menorrhagia, 402 

Savine, oil of, TTl 5 to 10 (0.3-0.60), in 
capsule or emulsion, every three or four 
hours, as a tonic in menorrhagia, 414 
Turpentine, often of value, 451 

MENSTRUATION. 

Suppression of, due to cold, aconite in, 62 

MIGRAINE, 736 

Ammonium benzoate, gr. 10 to 20 (0.6- 

1.3), 736 
Amyl nitrite, 84 
Bromide of potassium, with caffeine, 

almost a specific, if due to eve-strain, 

128 
Cannabis indica, extract, gr. \ to % (0.015- 

0.03) with tincture of gelsemium, gtt. 10 

to 20 (0.60-1.3) every two hours, 145, 736 
Croton chloral, very efficient, especially if 

fifth nerve is involved, 221 
Gelsemium, with cannabis indica, to abort, 

256, 736 
Methylene blue, gr. 1 to 2 (0.06-0.12), in 

capsule, 335 
Phenacetin, 379 



894 



INDEX OF DISEASES AND REMEDIES. 



Rachford's prescription for, 736 

Salicylic acid, of great service in rheumatic 

types, 406, 736 
Sodium phosphate in hot water taken in 

morning, 736 
Starr's prescription for, 737 

MILK DEFICIENCY, 772 

Electricity, 772 

Treatment for intercurrent affection, if due 
to such cause, 772 

MORPHIOMANIA. (See Poisoning from 

Opium, Chronic.) 
Bromide of potassium, 128 
Phosphorus, of service in sequelae of mor- 
phiomania, 384 

MUCOUS MEMBRANE (DISEASES OF). 

Acacia, as a mucilaginous drink in irrita- 
tion and inflammation of upper air- 
passages, 53 

Bismuth, as an astringent, to inflamed 
membranes, 120 

Flaxseed, as a soothing demulcent, 252 

Glycerole of aloes, locally applied to fis- 
sures, valuable, 74 

Opium, suppositories, gr. \ (0.015), useful 
in rectal inflammation, if not an acute 
catarrh, 362 

Pareira, useful in chronic genito-urinary 
inflammation, 373 

Tannic acid, useful in depressed conditions, 
439 

Terebene, useful in subacute and chronic 
genito-urinary inflammation, instead of 
sandalwood or copaiba, 441 

Zinc sulphate, weak solution, as an astrin- 
gent, 459 

MUSOffi VOLITANTES, 737 

Alteratives and correction of anomalies of 
refraction, 747 

MUSCULAR STIFFNESS. 

Hot laundry iron passed over part, skin 
being protected by layers of paper or 
cloth, often relieves, 504 

MYALGIA, 737 

Ammonium chloride, if due to cold or 

bruises, 737 
Camphor liniment, 143 
Chloroform liniment, 738 
Cimicifuga, fluid extract, TT1 20 to 1 drachm 

(1.3-4.0), 737 
Clove oil, added to liniment, as a counter- 
irritant, 199 
Iodide of potassium or salicylates, if due 

to rheumatism, 737 
Iodine ointment, pure or diluted with lard, 

737 
Massage or good rubbing, very necessary, 

738 
Potassium acetate or citrate, gr. 20 (1.3), 

may be tried, 737 
Poultices, hot as can be borne, 738 
Prescription for liniment, 737 



MYXOEDEMA. 

Thyroid gland, or extract of, a specific for 
447 

NASAL CATARRH (ATROPHIC), 738 

DobelFs solution, as a cleansing wash; 
carbolic acid may be increased, or 
thymol and eucalyptus substituted for 
it, to relieve odor, 738 

Galvano-cautery, or strong silver nitrate 
solution, if ulcerations are present, 739 

Hydrogen peroxide, 738 

Ichthyol, useful, 738 

Iodine and glycerin (gr. 6 to 8 to the ounce 
[0.4-0.5:30.0]), with potassium iodide 
sufficient to cause solution of the iodine, 
valuable locally applied, 739 

Potassium iodide internally, tonics and 
stimulants to mucous membrane, and 
attention to activity of skin, 739 

Potassium permanganate, useful; painful 
if sensation is not entirely lost, 738 

Removal of necrosed bone, 739 

Silver nitrate and starch (gr. 1 to 10 [0.06- 
0.60] to drachms 2\ [10.0]), as an insuf- 
flation powder, or solution (gr. 1 to 10 
to the ounce [0.06-0.60:30.0]), better 
in some cases, locally applied, 739 

NASAL CATARRH (CHRONIC), 739 

Arsenic, 103 

Camphor, 142 

Ferric alum (gr. 5 to the ounce [0.3:30.0]), 
useful, in spray, in later stage, 740 

Galvano-cautery or snare, to remove hyper- 
trophic tissue remaining after acute 
stage, 741 

Hydrastis, dilute solution or distilled ex- 
tract of hamamelis and water, equal 
parts, useful in spray, in acute staee, 
740 

Iodine and glycerin (gr. 6 to 8 to the ounce 
[0.4-0.6:30^0]), with potassium iodide 
sufficient to cause solution of the iodine, 
locally applied, 740 

Prescription for alkaline wash, 740 

NAUSEA. (See Vomiting.) 

Hoffmann's anodyne, when due to excessive 

use of tobacco, 266 
Hydrocyanic acid, dilute, ttl 3 (0.20), in 

water, often useful, 271 
Lime-water, 140 

NEPHRITIS (ACUTE), 741 

Aconite, to depress circulation, 741 

Blisters contraindicated, 741 

Bromides or opium, given cautiously if 

aconite fails to quiet restlessness, 741 
Caffeine, in later stages, 742 
Cannabis indica, if hematuria is present, 

also to allay pain over kidneys, 146, 741 
Cantharides, £ to 1 minim (0.025-0.05), of 

tincture" about fifth day, when kidneys 

are atonic, also if hsematuria is present, 

148, 741 
Citrate of potassium and sweet spirit of 

nitre, to increase flow of urine, 741 



INDEX OF DISEASES AND REMEDIES. 



895 



Cups or leeches over loins if urine is scanty, 
741 

Digitalis, with squill or calomel, gradually 
increased, followed by gin or compound 
spirit of juniper in later stages, 741 

Elaterium, to relieve dropsy, 741 

Flaxseed tea, as a demulcent, 252, 741 

Gallic acid and ergot to control excessive 
hematuria, 742 

Hot-air baths, useful to provoke sweat, 741 

Iron, if anaemia be present, also to decrease 
albuminuria, 742 

Juniper, to re-establish secretion, after 
inflammation has subsided, 301, 742 

Milk diet, 742 

Pilocarpine hydrochloride, gr. ^ tof (0.003- 
0.008), hypodermically, if ursemia threat- 
ens, repeated in fifteen minutes if no 
sweat appears, but guarded by strych- 
nine, when the heart is weak, 389, 741 

Potassium bitartrate, 122 

Sulphate of magnesium, gss (16.0), or 
calomel, to aid in elimination of toxic 
products by bowel, 741 

Turkish bath, to aid in eliminating effete 
products, used with care, 506 

NEPHRITIS (CHRONIC), 742 

Basham's mixture for anaemia, 294, 743 

Bichloride and protiodide of mercury, 332 

Cannabis indica, to allay pain over kidneys, 
also if hsematuria is present, 146 

Cantharides, particularly useful if due to 
alcoholism, 148, 743 

Capsicum, to check albuminuria, 150 

Chloride of gold and sodium has been 
recommended in interstitial forms, 261 

Chloride of iron if anaemia is present; also 
to decrease albuminuria, 295, 743 

Digitalis and caffeine useful, 742 

Elaterium or jalap, to relieve dropsy, 743 

Juniper of value, 743 

Methylene -blue solution hypodermically, 
when kidney is suspected of being in- 
adequate, 743 

Milk diet, 742 

Nitroglycerin useful in ascending doses in 
chronic parenchymatous nephritis, 346, 
743 

Oxygen inhalations, 743 

Potassium acetate or bitartrate combined 
with digitalis, or the bitartrate combined 
with gin or compound infusion of juniper, 
122, 742 

Potassium iodide, gr. 5 (0.3), thrice daily, 
used with great care, 281 

Sodium iodide, of great value in many 
cases, 743 

Squill, 425, 742 

Strontium lactate, for the relief of albu- 
minuria, 428 

NEPHRITIS (INTERSTITIAL). 

Nitroglycerin with cardiac disturbance and 
high arterial tension, 346 

NERVOUSNESS. 

Ammonium valerianate in nervous unrest 
of pregnancy or hysteria. 83 



Asafcetida in nervous irritability of chil- 
dren, 110 

Bromides, 127 

Camphor, as a sedative, 142 

Hops, as a sedative, 269 

Musk, useful in nervous excitement and col- 
lapse; only to be used through crisis, 
337 

Phosphorus, in nervous debility and ex- 
haustion, 384 

"Pill of three valerianates," highly recom- 
mended, 453 

Rest-cure very useful where nervousness 
is due to exhaustion, 528 

Strychnine, in functional nervous atony or 
depression, 353 

Suprarenal gland, 436 

Sumbul, prescription for, 435 

Sweet spirit of nitre, in nervous excitement 
of fever and other nervous states of in- 
fancy, 438 

Valerian, alone or with other drugs, 453 

NEURALGIA, 743 

Acetanilid, useful, especially with mono- 
bromated camphor, 57, 745 

Aconite ointment (gr. 2 to the drachm [0.12 : 
4.0]), or oleate of aconitine (gr. 2 [0.12] 
to sweet oil 100 minims [6.6]), useful ap- 
plied over painful spot, if limited in area, 
62, 745 

Acupuncture, nerve-stretching, or neurec- 
tomy, necessary in some cases, 746 

Ammonium chloride, in ovarian neuralgia, 
82 

Amyl nitrite, inhalations, when due to 
anaemia, 745 

Antipyrin, very useful, especially in gout, 
rheumatism, or nervous depression, 93, 
745 

Belladonna, 115, 118 

Bromide of potassium with caffeine, almost 
a specific, 128, 745 

Prescription for, 128, 745 

Camphor liniment, locally applied, to re- 
lieve pain, 143 

Castor oil, oz. 1 to 2 (30.0-60.0) a day, at 
times gives good results, 746 

Chloralformamide, 166 

Chloretone and antipyrin (3 to 6 grains 
[0.20-0.4]), 169 

Chloroform by kataphoresis, 524 

Chloroform liniment, as a local anaesthetic, 
183, 746 

Cimicifuga, especiallv useful in ovarian 
types, 189 

Cod-liver oil, 208, 744 

Cold applications, locally, 472 

Croton chloral, gr. 5 to 20 (0.3-1.3), in 5- 
grain pills, often effective in brow neu- 
ralgia, 221, 745 

Duquesnel's crystalline aconitine in obsti- 
nate forms, 63 

Freezing parts with ether or rhigolene 
sprav or bv small packages of ice and 
salt,*243, 472, 745 

Guaiacol used locally, of value, 263 

Hydrocvanic acid, useful in intestinal neu- 
ralgia, 273 



896 



INDEX OF DISEASES AND REMEDIES 



Iodide of potassium, may be tried in rheu- 
matic neuralgia, 284 

Iron and arsenic, in anaemia; often neces- 
sary to associate with them bitter tonics 
and cod-liver oil, 744 

Kataphoresis, 524, 745 

Menthol, locally, 375 

Morphine, gr. \ to \ (0.012-0.015), injected 
into painful spot, if localized ; not ad- 
visable in chronic cases, 746 

Muriate of ammonium, useful in ovarian 
types, 82 

Mustard plaster, as a counterirritant, 337 

Nux vomica or strychnine, if nerve is de- 
pressed by anaemia, 744 

Peppermint oil, locally applied on cloth 
over painful spot, 374 

Phenacetin, gr. 3 to 8 (0.20-0.5), very use- 
ful, prescription for, 379, 744 

Phenocoll, 380 

Phosphorus, if due to nervous exhaustion, 
384, 744 

Potassium iodide, 280 

Prescriptions containing antipyrin with 
bromides and caffeine, 745 

Quinine, if due to malaria, 193, 744 

Rest-cure very useful in exhausted patients 
528 

Salol (phenyl salicylate), if due to expo- 
sure, 409 

Salophen, useful when combined with 
phenacetin, 410 

Specific remedies, if due to scrofulosis or 
syphilis, 744 

Turkish baths, may relieve if due to rheu- 
matism or gout, 506 

Veratrine ointment, locally applied, over 
neuralgic nerve, 454 

NIGHT-SCREAMING. 

Bromide of potassium, 127 

NIGHT-SWEATS. 

Acetic acid, as a lotion, diluted one-half, 59 

Agaricin, of doubtful value, 63 

Alum dissolved in water or alcohol, efficient 
application for sponging, 76 

Belladonna, best remedy, 115 

Camphoric acid, the best of all remedies, 144 

Ergot, 235 

Gallic acid, 254 

Pilocarpine, gr. J^ (0.003), hypodermically, 
two hours before sweat, often useful, 
even when atropine fails, 390 

Sulphuric acid, with belladonna or mor- 
phine, often useful, 434 

Zinc oxide, prescription for, 369 

NIPPLES (SORE), 746 

Benzoin, tincture, locally applied, 746 

Boric acid (gr. 20 to the ounce [1.3:30.0]), 
or mucilage of acacia, applied after 
nursing, nipple being dried beforehand, 
746 

Breast-pump or nipple-shield may be neces- 
sary to effect cure, 746 

Cocaine (gr. 4 to the ounce [0.25:30.0]), 
applied and washed off before nursing, 
if breast is very painful, 201, 746 



Ichthyol, when indurated, 278 

Prophylaxis, 746 

Silver-nitrate stick touched to fissure, if 

deep and slow to heal, 746 
Tannin, glycerite of, locally applied, 746 

NYMPHOMANIA. 

Bromide of potassium, of great service, 127 

OBESITY, 746 

Acetic acid, harmful, 59 

Cold bath, 749 

Diet, 748 

Laxative fruits and purges, to regulate 

bowels, 749 
Massage, passive movements, absolute 

skimmed-milk diet, and electricity, if 

exercise is impracticable, 749 
Potassium permanganate, 377 
Saline purges, 749 
Thyroid gland, 447 
Turkish bath, 749 

OPHTHALMIA. (See Conjunctivitis.) 

OPIUM HABIT. (See Poisoning from 
Opium, Chronic.) 

ORCHITIS. (See Epididymitis.) 

OSTEOMALACIA. 

Ovarian tract in, 259 
Phosphorus, 384 

OTITIS MEDIA. 

Dermatol as a dusting-powder in purulent 

forms, 122 
Potassium permanganate, gr. 1 to oz. 1 

(0.06-30.0) as a wash, 378 

0T0RRH03A. 

Creolin, solution (1 :500), used with syringe, 
221 

OXALURIA. 
Nitric acid, 345 
Nitro-hydrochloric acid, 349 

OZ-ffiNA. 

Ichthyol very useful in fetid ozaena, 278 
Prescriptions for insufflation powder, 325 

PARALYSIS AGITANS. 

Cannabis indica, to quiet tremors, 146 
Chloral, of great service, 164 
Duboisine sulphate of some use, 232 
Sparteine, 416 

PARASITES. 

Bichloride of mercury (gr. 2 [0.12] to water 
oz. 1 [30.0]), applied thrice daily in para- 
sitic skin diseases, 326 

Cajuput oil, applied pure, will destroy 
pediculi, 136 

Chrysarobin, gr. ■§■ (0.008), internally, or 
the ointment, with benzoated lard (1 :4 
or 5), locally applied, in parasitic skin 
diseases; must not be used on face, 189 



INDEX OF DISEASES AND REMEDIES. 



897 



Mercurial ointment, useful to destroy 
pediculus pubis or other parasites, 331 

Oil of cloves, 200 

Pyrogallol, 30 grains to the ounce (2.0: 
30.0), for parasitic skin disease or pso- 
riasis, 397 

Thiosulphate of sodium, 1 drachm to the 
ounce (4.0:30.0), for parasitic skin dis- 
ease, 423 

Volatile or fixed oils, useful to destroy, 331 

PARTURITION. 

Antipyrin for pains, of doubtful value, 

93 
Castor oil, to relieve constipation, 158 
Cimicifuga, 189 
Quinine, as a stimulant to uterus, 194 

PEMPHIGUS. 

Arsenic, 103 

PERICARDITIS, 750 

Aconite, to allav inflammation and quiet 
heart, 62, 750~ 

Alcohol, digitalis, or caffeine, if heart shows 
signs of failure, 750 

Aspiration, gradual, if exudation endangers 
life, 750 

Blister, over pra?cordium, often useful, 
750 

Elate rium, useful in effusions, 234 

Ice-bag over the preecordium, very useful, 
750 

Iodide of potassium, to aid in absorption 
of fluid, 280 

Leeches, 5 to 10, over prsecordium, accom- 
panied by large dose of veratrum viride 
in early stages of sthenic cases, 750 

Opium, to allay inflammation, 362 

PERITONITIS (ACUTE), 750 

Acetanilid, gr. 2 (0.12), every two or three 
hours, with brandv and ice, for vomiting, 
753 

Hyoscyamus, by suppository or injection, 
in collapse, 754 

Ice, with white of egg, for thirst. Vomit- 
ing does not contraindicate small 
amounts of water, 754 

Ice-bag or turpentine stupe to abdomen; 
leeches in sthenic cases, 753 

Opium, pushed until pain is relieved, but 
never to the point of obtunding intelli- 
gence, 362, 753 

Rectal tube, milk of asafcetida or turpen- 
tine injections, in tympanites, 754 

Salines, useful in cases following surgical 
operations, but contraindicated by fee- 
bleness, perforation, or obstruction, 754 

Surgical procedures, often necessary. When 
diagnosis is obscure or in septic general 
peritonitis exploratory incision is justi- 
fied, 752 

Veratrum, 456 

PERITONITIS (CHRONIC), 754 

Incision, with or without drainage and 
iodoform, useful in tubercular peritonitis, 
* 754 



PERNICIOUS MALARIAL FEVER, 755 

Morphine and atropine to control retching 

and vomiting, 755 
Quinine, large doses, in solution, by mouth, 

rectum, or hypodermically, 193, 755 
Thiosulphate of sodium, grs. 60 (4.0) to 

move the bowels, 755 

PHARYNGITIS. 

Antipyrin in 4 per cent, spray, 94 
Cocaine, gives temporarv relief; after- 
effects bad, 201 
Cubebs, troches of , used in chronic types, 223 
Monsel's solution, pure or diluted one-half 
with glycerin, applied on pledgets of 
cotton or camel's-hair brush, 298 
Peroxide of hydrogen, 274 
Potassium chlorate, as a gargle, 168 
Salol (phenyl salicylate), in 5-gr. (0.3) 

doses, 409 
Silver-nitrate solution, in varying strength, 

locally applied, 343 
Turkish bath, in acute forms, when phar- 
ynx feels raw, 506 

PHTHISIS. (See Tuberculosis.) 

PITYRIASIS VERSICOLOR. 

Anthrarobin in, 85 

PLEURITIS OR PLEURISY, 755 

Aconite or veratrum, preferable to vene- 
section, in early stage, 755 

Aspiration, when hydragogue purges fail 
to remove effusion, 757 

Bryonia, in pleurisy with effusion, 133 

Cantharidal blister, two inches below 
axilla, aids absorption of effusion, 492, 758 

Cotton jacket, 756 

Digitalis or alcohol, if pulse weakens in 
second stage, 756 

Elaterium or jalap, useful to remove effu- 
sion, 233, 757 

Gelsemium, 257 

Ice-poultice or jacket, used with success in 
sthenic cases, 472 

Iodide of potassium, used in chronic stage, 
to aid absorption, 280 

Iodine, locally applied, to abort, and aid 
absorption of fluid, 285 

Pilocarpine, 389 

Salicylates, verv useful for the removal of 
effusion, 406," 757 

Saline purges, in second stage, to remove 
effusion, 757 

Strapping chest, if respiratory movements 

are very painful, 755 
Veratrum, 456 

PLEURODYNIA. (See Neuralgia.) 

PNEUMONIA, 758 

Aconite, preferable to veratrum, in early 

stage, in children, 62, 759 
Alcohol, inferior to digitalis, as a cardiac 
stimulant in the second stage in adults, 
but better than in children, 66, 67, 760 
Ammonia useful for adults and children, 
I 78, 761 

57 



898 



INDEX OF DISEASES AND REMEDIES. 



Ammonium bromide and carbonate may 
be used if the chloride fails, 762 

Ammonium chloride, as an expectorant in 
third stage, 762 

Antipyrin, of great value, if fever is exces- 
sive, 92 

Asafcetida, by rectal injections, in tym- 
panites, 110 

Belladonna, very useful, if there are evi- 
dences of collapse, 117, 760 

Citrate of potassium, to maintain renal 
activity, 761 

Cold compresses, locally, 760 

Cold sponging for fever, 760 

Counterirritation in, 491, 492 

Digitalis, tincture, ffl 8 (0.5), every four 
hours, accompanied by belladonna, gtt. 
8 (0.5), carefully watched in second 
stage, 229, 761 

Dover's powder for pain at onset, 759 

Ethyl iodide, causes resolution, 247 

Gelsemium, in early stages, 257 

Gin, to maintain renal activity, 761 

Heroin, gr. J^ every eight hours, for exces- 
sive cough, 762 

Hoffmann's anodyne, useful, 761 

Hot foot-bath, useful at onset, 759 

Ice-bag to heart if fever be high and heart 
tumultuous, 760 

Ice-poultice or jacket, highly recommended 
in first stage of sthenic cases, 472 

Iodide of potassium, in later stages to 
absorb exudates, 281 

Morphine, for pain at onset, and for exces- 
sive cough, 761, 762 

Nitroglycerin, in high arterial tension with 
thickened arteries, 761 

Oxygen inhalations, if asphyxia threatens, 
369, 761 

Phosphorus, 384 

Prescriptions, containing ammonium chlo- 
ride, to loosen cough of second stage, 
762 

Quinine, gr. 2 (0.12) thrice daily, in sup- 
pository in lobar pneumonia of children, 
194 

Strychnine as a respiratory and circulatory 
stimulant in second stage and as an 
adjuvant to digitalis, 353, 761 

Sweet spirit of nitre to maintain renal ac- 
tivity, 761 

Venesection, in early stage of sthenic cases, 
cardiac depressants, preferable and late 
when heart is laboring and veins dis- 
tended, 540, 759, 761 

Veratrum, preferable to aconite, in early 
stage, in adults, 456, 759 

POISONING FROM— 

Acetanilid. 

Supportive measures, stimulants, external 
. heat, belladonna to maintain blood- 
pressure, strychnine to counteract res- 
piratory failure, and oxygen inhalations 
to overcome cyanosis, 56 

Acetate of Zinc. 

Treatment same as for gastro-enteritis, 
671 



Acetic Acid. 

Large amounts of milk, alkaline liquids, 
and general treatment for gastro-enter-' 
itis, 59 

Aconite. 

Keep patient in prone position, with feet 
higher than head. Hot applications; 
emetics contraindicated; evacuate stom- 
ach by siphon or stomach-pump. Ether 
hypodermically, followed by alcohol, and 
this by digitalis. Artificial respiration 
and amyl nitrite a few whiffs, no more, 
if heart fails; atropine, strychnine, 61 

Alcohol (Acute). 

External heat, digitalis and strychnine 
hypodermically, in coma, if heart fails. 
Belladonna, if the skin is relaxed and 
clammy, and counterirritation to nape 
of neck, for brain symptoms. After- 
treatment, ammonia, spices, spirit of 
mindererus; emollients in gastritis, ice, 
aconite, hydrochloric acid, or ipecac in 
minute dose, and coimterirritation for 
vomiting. Jalap, gr. 40 (2.6), elaterium, 
gr. I (0.01), or calomel and salines, as 
purgatives, 67 

Fowler's solution for morning vomiting, 68 

Alcohol (Chronic). 
Withdrawal of drug, at once or gradually. 
Highly seasoned broths, predigested 
food, and morphine or coca, in small 
dose, if weakness is marked. Capsicum 
prescriptions (pages 69, 150), 68, 69 

Antimony. 

Large doses of tannic acid, external heat, 
alcohol, digitalis, and opium hypoder- 
mically, if respiration is not too feeble. 
If necessary to use opium, it should be 
accompanied by strychnine. Prone posi- 
tion, the patient vomiting into towels. 
Stomach-pump, if vomiting is absent, 
89; atropine, 118 

Antipyrin. 
Maintain bodily heat, stimulants, atropine, 
and oxygen inhalations, if cyanosis is 
alarming, 92 

Arsenic (Acute and Chronic). 

Stomach-pump, external heat, stimulants, 
and the chemical antidote, hydrated 
sesquioxide of iron and magnesia. Mag- 
nesia also useful by itself. Opium should 
follow antidote, to allay pain, also large 
draughts of water to flush kidneys and 
dilute poison. For chronic poisoning, 
iodide of potassium, tonics, electricity, 
and out-of-door life, 107, 108 

Belladonna. 

External heat if collapse intervene, and 
strychnine to support respiration. The 
physiological antidote, opium, may be 
carefully given, 115 



INDEX OF DISEASES AND REMEDIES. 



899 



Carbolic Acid (Phenol). 
Soluble sulphates, as Epsom or Glauber 
salts, warm mucilaginous drinks, hot 
applications to extremities, digitalis, 
strychnine, and counterirritation over 
abdomen. Emetics and stomach-pump 
should be used if possible, 152 

Chloral. 

External heat, emetics in early and stom- 
ach-pump in later stages. Strychnine 
or atropine to stimulate respiration. 
Digitalis, preceded by ether, ammonia, 
brandy, or whiskey. Prone position, 
feet being elevated, 163 

Chloroform. 

Artificial respiration, ether and hot brandy 
hypodermic ally. Poles of battery with 
rapidly interrupted current swept over 
body, not over diaphragm or phrenic 
nerve. Place patient with head down- 
ward. Compression of the abdomen 
and limbs; compression and massage of 
the prapcordium. Atropine, strychnine, 
and digitalis to stimulate the heart and 
respiration. Laborde's lingual traction, 
183 

Cocaine. 

Ammonia, coffee, strychnine, ether, and 
alcohol. If convulsive in type, treat 
same as strychnine poisoning, 206 

Colchicum. 

Tannic acid, emetics, and stomach-pump. 
Opium to relieve pain, and oils. Atro- 
pine and stimulants if collapse comes 
on, 211 

Conium. 

Emetics or stomach-pump, strychnine as 
a nervous and respiratory stimulant, 
external heat, and cardiac stimulants, 
if circulation fails, 215 

Copper. 

Yellow prussiate of potassium, sweet oil, 
white of egg; followed instantly by 
emetics or stomach-pump. If emesis or 
purgation is present, emetics are contra- 
indicated; instead, mustard plaster over 
abdomen and opium, internally, are to 
be employed, 217 

Corrosive Sublimate. 

Large amounts of white of egg, followed 
by stomach-pump, external heat, stimu- 
lants, 325 

Croton Oil. 

Treatment same as for gastro-enteritis, 671 

Digitalis. 

Tannic acid as a chemical antidote, emetics 
or stomach-pump, external heat to ab- 
domen, and aconite as a physiological 
antidote. Maintain horizontal position, 

228 



Elaterium. 
Treatment same as for gastro-enteritis, 671 

Ether. 
Artificial respiration, lowering head if face 
is pale; strychnine, atropine, and digi- 
talis hypodermically,.or intravenous in- 
jection of ammonia to stimulate heart 
and respiration; friction and hot ap- 
plications; ether dashed on chest and 
abdomen; Laborde's method of traction 
of the tongue, 240 

Eucaine, 

Treatment like that of cocaine intoxica- 
tion, 206 

Gelsemium. 
Emetics and stomach-pump, digitalis, atro- 
pine, and ammonia as cardiac stimu- 
lants; external heat, strychnine, and 
. atropine for respiratory centre, 257 

Iodine. 

Emetics or stomach-pump, large amounts 
of starch, hot applications, and hypo- 
dermic injections of alcohol, ammonia, 
atropine, digitalis, or strychnine, 283 

Iodoform. 

Sodium bicarbonate to combine with iodine 
alcohol, diuretics, and hot blankets; 
saline transfusion, 287 

Lead (Acute). 

Epsom or Glauber salts, in large amounts; 
alum; emetics or stomach-pump. Hot 
applications and opium to relieve pain, 
304 

Lead (Chronic). 

Jalap and calomel with opium or alum, 
gr. 2 (0.12), in full dose, valuable in lead 
colic. Blister to back of neck, revulsives 
and pilocarpine in cerebral inflamma- 
tion. Iodide of potassium to eliminate 
lead. Strychnine in yjrogressive paraly- 
sis. Electricity and baths of sulphuret 
of potassium, 304 

Mineral Acids. 
Alkalies, such as magnesium, lime, white- 
wash, and soap as antidotes; white of 
egg, external heat, oils, and opium, to 
relieve irritation, 

Monsel's Solution. 
Soap, 298 

Nitrate of Silver (Acute). 
Common salt as the chemical antidote, 
opium and oils to allay irritation; also 
large amounts of milk and soap and 
water; maintain bodily heat, 341 

Nitrate of Silver (Chronic). 
Iodide of potassium, to aid in eliminating 
poison, 341 



soo 



INDEX OF DISEASES AND REMEDIES. 



Nux Vomica and its Alkaloids. 

Inhalations of amyl nitrite, to prevent con- 
vulsive tendencies; at the same time use 
stomach-pump. Tannic acid followed 
by physiological antidotes, potassium 
bromide, gr. 60 (2.0), with chloral, gr. 
20 (1.3). If convulsions prevent swal- 
lowing, chloroform patient Carefully 
and give antidotes by rectum in starch- 
water. Amyl nitrite, hypodermically, 
if relaxation does not occur, 355 

Opium (Acute). 
Emetics, or stomach-pump, tannic acid? 
black coffee, electricity, and other meas- 
ures to keep patient awake. Atropine 
or strychnine, hypodermically, if respi- 
ration fails. Alcohol, ammonia, and 
external heat. Artificial respiration 
may be necessary; repeated washing 
out of stomach. Permanganate of po- 
tassium, 358 

Opium (Chronic). 

Decrease a sixth or fourth of customary 
amount each twenty-four hours. Co- 
caine not advisable as a substitute, as 
the cocaine-habit may be established. 
Digitalis and strychnine if heart fails. 

Hvoscine hvdrobromide in large doses verv 
Valuable," 359, 360 

Phosphorus. 

Permanganate of potassium, 1 per cent, 
solution, or peroxide of hydrogen. Sul- 
phate of copper is too poisonous in itself, 
384 

Physostigma. 

Atropine as a physiological antidote, ex- 
ternal heat, and cardiac and respiratory 
stimulants, 386 

Scammony. 

Treatment same as for gastro-enteritis, 671 

Strychnine. (See Nux Vomica.) 

Veratrum. 

Prone position, head higher than feet; 
atropine, strychnine, external heat, and 
cardiac stimulants, 455, 456 

POST-PARTUM HEMORRHAGE.701,770 

Adrenalin chloride, 702 
Auto-transfusion, or actual transfusion of 

weak salt solution, necessary in some 

cases, 772 
Beef-tea. \ pint (240.0), and morphine gr. 

\ (0.008) hypodermically, after reaction 

is established, 772 
Correction of displacement sometimes nec- 
essary, 770 
Drugs have been recommended, but are 

dangerous as local applications, 771 
Enema of hot normal salt solution, 1 pint 

(480.0), after cessation of bleeding, 772 
Ergot, as a cure and prophylactic, 235, 

701, 771 



Ether, hypodermically, if symptoms of 

shock are manifested, followed by small 

doses of hot, strong brandy and water, 

and warm milk, 771 

Faradism of uterine muscle, 771 

Gauze, preferably iodoform, packed into 

uterine cavity, 771 
Ice, used externally and internally, 771 
Injections of lemon-juice, vinegar, or hot 

water, 702, 771 
Manipulations of the uterus, 701, 771 
Method to pursue when caused by hsema- 

toma, 770 
Suture, if due to laceration, 771 



Hops. 269 



PRIAPISM. 



PROLAPSUS ANI AND RECTI. 

Injection of cold or hot water, often 

relieves, 475 
Quercus, infusion, 398 

PROSTATITIS, 678 

Cold-water injections and perineal douches, 

476, 678 
Local treatment to prostatic urethra, and 

use of cold steel sounds in chronic tvpes, 

679 
Perineal incision, to evacuate pus, if 

abscess forms, 678 
Rest in bed, regulation of bowels, leeches 

to perineum, medication to render urine 

alkaline, and morphine hypodermically 

or in suppository, 678 
Soft catheter, allowed to remain in bladder, 

if retention of urine is persistent, 678 

PR0STAT0RRHC3A. 

Cantharides, 148 

PRURIGO. 

Cantharides, 148 

PRURITUS, 763 

Alum solution in pruritus vulvsp, 76 

Arsenic, quinine, bitter tonics, cod-liver 
oil, alkaline diuretics or mineral waters, 
in debility, and avoidance of condiments 
if mouth of vagina or urethra is affected, 
103, 763 

Boric acid, 123 

Calomel and lard (1 drachm to the ounce 
[4.0:30.0]), locally applied, 330 

Chloride of calcium, prescription for, 138 

Chloroform may be used, 764 

Cocaine, relieves temporarily, 764 

Cold douche and injections highly recom- 
mended in pruritus ani and vulva?, 
476 

Goulard's extract, dilute, useful in pruritus 
pudendi, 308 

Hydrocyanic acid, locally applied, 273 

Ivory plug for, 764 

Phenol, 763; prescriptions for, 154 

Prescriptions for lotions and ointments, 

763 
'Salicylic acid, prescription for, 406 



INDEX OF DISEASES AND REMEDIES. 



901 



Silver nitrate (gr. 20 to the ounce [1.3: 
30.0]), locally applied, preceded by 
cocaine, if itching is intense; a 4- to 6- 
grain (0.25-0.4) solution may relieve 
itching of pruritus pudendi, ani and 
vulvae, 343, 764 

Sodium bicarbonate or borax (1 drachm to 
the pint [4.0:480.0]), as a wash, 763 

Lead-water useful in pruritus pudendi, 308 

Sodium thiosulphate, gr. 30 to the ounce 
(2.0-30.0), locally, 423 

Teucrium scordium, highly recommended 
by Brinton, 764 

Turkish baths, 764 

P SEUDOLEUKJEMIA. 

Arsenic internally, and injections of Fow- 
ler's solution into glands, 101 

PSORIASIS. 

Ammoniated mercury in, 324 

Anthrarobin, 85 

Aristol, 445 

Arsenic, 103 

Cantharides. 148 

Chrysarobin, gr. ■& (0.008) internally, or the 

ointment with benzoated lard (1 to 4 

or 5), locally applied, face excepted; 

prescription for application, 188 
Gallic acid, ointment, 254 
Pvrogallol, 30 grains to ounce (2.0:30.0) 

of lard, 397 
Resorcinol, prescription for, 399 
Tar, locally applied, 440 
Thymol iodide, 445 
Thyroid gland, 447 

PTYALISM. 

Alum, applied on swab, in mercurial 

ptyalism, 76 
Belladonna, in idiopathic or mercurial 

types, 115 

PUERPERAL DISEASES, 764 

(For treatment see special titles.) 

PUERPERAL FEVER, 764 

Antipyretics, best abstained from as long 
as possible, 766 

Antistreptococcic serum, nuclein, and injec- 
tions of normal salt solution important 
adjuvants, 766 

Bichloride of mercury (1:2000), or iodine 
solutions, as antiseptic injections, 765 

Boric acid, creolin (2 per cent.), or bichlo- 
ride (1:8000; , solutions, as injections 
into bladder, to prevent septic cystitis, 
768 

Curette or placental forceps, to remove 
membranes if fever continues after anti- 
septic injections, 765 

Epsom salts, concentrated solution, 2 
drachms (8.0) every fifteen minutes, if 
peritonitis develops, 767 

Hot fomentations, or ice-bag, and later 
compresses dipped in lead-water and 
laudanum, 769 

Laparotomy occasionally saves life, if 
septic peritonitis develops, 766 



Nutriment in large amounts and alcoholic 
stimulants, if symptoms of systemic 
invasion arise, 766 

Silver nitrate (gr. 40 to 60 to the ounce 
[2.60-4.0:30.0]), locally applied to un- 
healthy ulcerated wounds; zinc chloride 
solution may be necessary, 767 

Veratrum, 456 

PURPURA HEMORRHAGICA. 

Turpentine, 451 

PYELITIS. 

Buclm in chronic types, 133 

Cantharides, 148 

Copaiba, 216 

Juniper, as a tonic in chrome types, 301 

Pareira, 373 

Uva ursi, 452 

QUINSY. 

Aconite, in early stage, 62 

Salicylic acid, gr. 3 (0.20), hourly, acts as 
a specific, especially if due to rheuma- 
tism, 406 

REMITTENT FEVER 776 

Cool sponging with friction if fever is 
excessive, 776 

Eupatorium, 250 

Monsel's salt, gallic or tannic acid inter- 
nally, if intestinal hemorrhage occurs, 
776' 

Morphine, spirit of chloroform, or aconite, 
in sthenic cases, to control vomiting, 
776 

Quinine, gr. 20 to 30 (1.3-2.0), preceded bv 
calomel, gr. 3 to 4 (0.20-0.25) : if not re 
tained, administer by rectum, or hypo- 
dermically, with divided doses of Seid- 
litz powder by mouth, 193, 776 

Tonics, potassium salts, to regulate kidneys 
and purgatives, if necessary, during con- 
valescence, 777 

Turpentine stupe, if belly is tender, 776 

RETINITIS 777 
Atropine, dark glasses, and later suitable 
lenses, if due to eye-strain, 777 

RHEUMATISM, ACUTE (ARTICULAR), 

777 
Acetanilid, relieves pain and fever, 57, 

779 
Acetate of potassium, 58 
Aconite, or veratrum, useful at onset of 

inflammation in sthenic cases, 777 
Aspirin in acute cases. 111 
Ammonium bromide and phosphate. 81 
Antimonial powder as an antipyretic, 89 
Antipyrin, gr. 5 to 10 (0.3-0.60), or anti- 

febrin, gr. 4 to 8 (0.25-0.5), often very 

valuable, 93, 779 
Benzoic acid, drachms 2 to 3 (8.0-12.0), 

daily, said to be a specific, 119 
Bicarbonate or citrate of potassium, gr. 20 

to 30 (1.3-2.0), in water, every five 

hours, in obstinate cases, 780 
Bicarbonate of sodium, 421, 778, 779 



902 



INDEX OF DISEASES AND REMEDIES 



Blisters over joints, useful after systemic 

disturbance is past, 781 
Caffeine useful to support the heart, 779 
Camphor liniment, 143 
Capsicum plaster, 150 
Cimicifuga, shortens attack and relieves 

pain in some cases, 189, 781 
Colchicum, prescription for, 211, 780 
Puller's lotion, applied on hot cloths to 

joints, 778 
Guaiac, 262 
Ice-cold compress, may relieve inflamed 

joints, 778 
Ichthyol, ointment, valuable, applied to 

joints, prescription for, 277, 778, 781 
Iodine, ointment or tincture, painted over 

parts, 781 
Leeches, over prsecordium in endocarditis, 

during, 781 
Lemon- or lime-juice, or citric acid, bene- 
ficial in nearly all cases, 199, 781 
Oil of gaultheria, useful as a substitute for 

salicylic acid; also used as a local appli- 
cation to the joints, 256 
Oleum succini, applied locallv over joints, 

77 
Phenacetin, alone or with salol, 379, 779 
Phenocoll, 380 
Potassium iodide, useful in subacute or 

obstinate types, prescription, 280, 780 
Potassium nitrate, 340 
Rhus toxicodendron, especially useful for 

night pains, 781 
Salicylic acid, applied to joints in a salve 

when stomach is irritable, 406, 778 
Salicylic acid, gr. 20 (1.3) thrice daily; if 

untoward symptoms arise, it must be 

stopped, 405, 779 
Salol (phenyl salicylate), useful as a sub- 
stitute for salicylic acid; dangerous in 

large doses, 409 
Sodium bicarbonate (gr. 20 to the ounce 

[1.3:30.0]), to inflamed joints, 421 
Splints for fixation of limbs, may relieve 

greatly, 778 
Veratrine ointment, used locally, applied 

to joints, 781 

RHEUMATISM (CHRONIC), 782 

Arsenic, useful in some cases, 103 

Cimicifuga, sometimes relieves, 189 

Citric acid, 198 

Cod-liver oil, internally; also useful rubbed 
into joints, 208, 782 

Colchicum, with iodide of potassium, pre- 
scription for, 210 

Hot-air bath, 510, 511 

Ichthyol, the best remedy for joints, 783 

Iodine, locally applied, 285 

Liniments, prescriptions for, 782 

Ointments, prescriptions for, 783 

Potassium iodide, colchicum, and sarsa- 
parilla, usuallv indicated; see prescrip- 
tions, 280, 782 

Salophen, 410 

Sulphur, 432 

Turkish or Russian baths, very valuable, 
506, 782 

Veratrine ointment, gives greatest relief in 
some cases, prescription for, 454, 783 



RHEUMATISM (MUSCULAR). 

Acetanilid in subacute, 57 

Burgundy pitch, a mild local remedy, 393 

Croton-oil liniment, 222 

Dover's powder in conjunction with hot 

drinks and hot foot-baths, often cures, 

363 
Mustard, as a counterirritant, 337 
Oil of cloves in liniment, locally, 199 
Pitch, locally, 393 
Salicin, as a substitute for salicvlic acid, 

403 
Salicin useful, 403 
Salol useful, 409 
Veratrine ointment, locally applied, 454 

RHINITIS. 

Creolin (1:1000), as a nasal douche, 221 
Fluid cosmoline, in spray, 378 
Potassium permanganate, solution, in foetid 
rhinitis, 378 

RHUS POISONING. 

Grindelia, 262 

Infusion of lobelia, 312 

Lead acetate, 307 

Liquor plumbi subacetatis, 307 

RICKETS, 783 

Arsenite of copper, 784 

Cinchona, or strychnine, 784 

Cod-liver oil, prescription for, 208, 784 

Cool sponging or rubbing with salt and 
whiskey (1 drachm to the pint [4.0: 
480.0]), useful at night, 785 

Hypophosphites and lactophosphates use- 
ful, 139 

Iodide of iron, syrup of, if scrofulous tend- 
ency or anaemia exists, prescription for, 
784 

Lime salts, phosphorus, zinc phosphide, as 
bone tonics, 784 

Massage and passive movements, 785 

Mineral acids, physostigma and simple 
bitters, as digestive tonics, 784 

Nux vomica, rarely given because of bitter- 
ness, 784 

Phosphorus (gr. yj^ [0.0006]), in sugar- 
coated pill, 384, 785 

Quinine, cod-liver oil, nux vomica, and 
iron as general tonics, 784 

Sodium and lime salts, useful in. nursing 
and pregnant women, 784 

Sodium phosphate to regulate the bowels, 
381 

RINGWORM. (See Tinea Circinata.) 

SATYRIASIS. 

Potassium bromide, one of the best reme- 
dies, 127 

SCABIES. 
Sulphur, the best remedy, 433 

SCARLET FEVER, 785 

Aconite, harmful if constantly employed, 

62 
Alcohol, indicated in collapse, 787 



INDEX OF DISEASES AND REMEDIES. 



903 



Antidiphtheritic serum when false mem- 
brane forms in throat, 787 

Antipyrin or acetaiiihd, may produce col- 
lapse in large doses, 90, 787 

Antistreptococcic serum, 470 

Bromide of sodium, with chloral, useful 
when convulsion ushers in attack, 786 

Chloral, very useful, prescription for, 786 

Chlorate of potassium, locally applied by 
spray or swab, in sore throat, 787 

Cold sponging, useful, 787 

Ice applied externally and held in mouth, 
to prevent swelling of throat, 787 

Ice-bag or rubber head-coil to head, if verv 
hot, 787 

Juniper, in later stages, if there is renal 
atonv, 301 

Phenol" (HI 2 [0.1] to olive oil oz. 2 [60.0]), 
benzoated lard, vaseline, cosmoline, or 
almond oil, useful, locally applied, to 
allay itching, 788 

Potassium citrate and sweet spirit of nitre, 
prescription for, 786 

Potassium permanganate (gr. 20 to pint 1) 
(1.3-480.0), as a gargle, 377 

Quinine, unsuccessful in most cases, 787 

Salicylic acid, highly recommended, pre- 
scription for, 786 

Strychnine, iron, simple bitters, quinine, or 
Basham's mixture, in convalescence, 
788 _ 

Sweating necessary in nephritis, 788 

AYarm wet pack, useful to bring out rash, 
788 

Water, pure, s\ich as Vichy or Poland, in 
large amounts, 786 

SCIATICA 788 

Absolute rest of limb in splints verv 

needful, 789 
Acetanilid and antipyrin, 57, 789 
Acupuncture, recommended, 461, 789 
Chloroform, deeply injected over exit of 

nerve, a favorable remedy, 182, 789 
Cod-liver oil, of service in obstinate cases, 

208, 789 
Ether or rhigolene sprayed on part, often 

effective, 789 
Hot-water bags, placed around exit of 

sciatic nerve, 789 
Liniments for rheumatism, may be tried, 

789 
Massage of nerve with glass rod, 789 
Methylene blue, gr. 5, twice or thrice a 

day to relieve pain, 789 
Morphine, injected over course of nerve, 

789 
Nerve-stretching, 789 
Opium subcutaneousry over affected part, 

361 
Potassium bitartrate or citrate, gr. 40 (2.6) 

thrice daily, in plenty of water, to I 

regulate kidneys, 789 
Potassium iodide, 280 
Remedies for rheumatism, often relieve, 

789 
Salicvlic acid, 405 
Sulphur. 432 
Wet or dry cups, highly beneficial over 

course of nerve, 789 



SCLERITIS, 789 

Atropine, boric acid and hot-water com- 
presses, in early stages, 789 

Eserine, with pilocarpine sweats or cautery, 
in stubborn episcleritis without iritis, 
790 

Specific treatment, in syphilitic cases, 790 

Yellow-oxide ointment, associated with 
massage to subdue infiltration, 790 

SCLEROSIS. 

Antipyrin, 93 
Nitrate of silver, 342 

SCROFULOSIS, 790 

Arsenic or corrosive sublimate, useful if 
anaemia is present, prescriptions for, 790 

Calcium chloride, 138 

Cod-liver oil, the best remedy, 208, 790 

Diet and exercise, 790 

Europhen in scrofuloderm, 251 

Excision, or scraping gland, and packing 
with iodoform gauze if other treatment 
fail, 791 

Hypophosphite of calcium, 139 

Ichthyol ointment, useful, rubbed into per- 
sistent enlargements, prescription for. 
791 

Iodine ointment and lard, equal parts, 
rubbed into glands, stopping at first 
sign of reddening or fluctuation, 791 

Iron, syrup of the iodide, in anaemia, pre- 
scription for, 297, 790 

Lactophosphates, or hypophosphites, with 
cod-liver oil, useful in young children, 790 

Phosphate of sodium or lime, if glands are 
breaking down, 139 

Sulphurate of calcium, if suppuration is 
active, 791 

Thiol, recommended in scrofulous skin dis- 
eases, 443 

SCURVY, 791 

Arsenic and iron, of service in most cases, 
791 

Citric acid, if lemon-juice is not attainable, 
198, 791 

Diet, 791 

Lemon- or lime-juice, particularly indi- 
cated, 791 

SEA-SICKNESS. 

Bromides, the best prophylactics, 128 

Chloralformamide and potassium bromide, 
166 

Nitrite of amvl, 84 

Kola, 303 

SHOCK. 792 

Adrenalin chloride solution 1 :1000, \ 
drachm in 1 pint of hot normal saline 
solution injected into a vein, 436 793 

Alcohol, 66 

Atropine, gr. ^ to -^ (0.001-0.0012) hypo- 
dermically, with hot applications, very 
useful in first or second stage, 117, 793 

Digitalis, valuable as an adjuvant to atro- 
pine, 229, 793 

Heat, external, very useful, 793 

Hypodermoclysis, useful, 513, 793 

Strychnine, very valuable, 354 



904 



INDEX OF DISEASES AND REMEDIES. 



SKIN DISEASES. 

Arsenate of iron, 294 

Arsenic, in dry, scaly types, 102 

Bismuth subgallate, when there is much 
secretion, 121 

Boroglycerin, 124 

Chrysarobin locally in parasitic diseases, 
188 

Cod-liver oil, in strumous types, 208 

Copper sulphate, gr. J^ (0.006) thrice daily, 
if arsenic is not well borne, 217 

Corrosive sublimate, oz. -|- (16.0), and am- 
monium chloride, oz. 1 (30.0), useful, 
added to bath, in syphiloderm, 326 

Hydrocyanic acid, in itching types, pre- 
scription for, 273 

Ichthyol in those forms associated with 
atony and induration of the deeper 
layers, 278 

Ointment of biniodide and of yellow oxide 
and lard, in equal parts, useful applica- 
tion, 327, 332 

Petrolatum, as an emollient dressing, 378 

Sodium thiosulphate in pityriasis versi- 
color, 423 

Tar and suet, equal parts, locally applied 
except on face, 440 

Unguentum hydrargyri ammoniati, 324 

Zinc-oxide ointment, 368 

SMALLPOX, 793 

Aconite, with spirits of nitre and Min- 
dereus, useful as a fever mixture, 793 

Antipyrin or acetanilid, to control head- 
ache and backache, 92, 794 

Brandy and whiskey, if pulse fails, 794 

Bromides and chloral, in insomnia; latter 
must be used carefully, 794 

Chlorate of potassium with tincture of 
myrrh, as a mouth-wash, 794 

Disinfection and hygiene necessary, 794 

Flexible collodion, glycerite of starch, or 
simple cerate, locally applied, to prevent 
itching, 794 

Iron, tincture of the chloride, to give 
strength and act as a specific, 794 

Mustard plasters contraindicated, 794 

Opium for restlessness caused by itching, 
362 

Phenol and sweet oil (1 :100), as an oint- 
ment to check irritation, 794 

Phenol, pure, touched to the vesicles to 
decrease pustulation, secondary fever, 
and pitting, 154 

Salicylic acid and vaseline, or cold cream 
(4:100), best local application, 794 

Silver nitrate, locally applied, to prevent 
pitting, 342, 794 

SORDES. 

Glycerin and water, equal parts, useful as 
a mouth-wash, 260 

SORES. 

Acetic acid, in old sores, 59 
Black wash, useful for syphilitic sores, 327 
Camphor, locally applied, as a stimulant in 
indolent sores, 143 



Charcoal, applied to old sores, as a deodor- 
ant and antiseptic, 155 

Cold cream, as an emollient dressing, 
402 

Dried alum a useful dressing, 76 

Formaldehyde solution useful for cauter- 
izing syphilitic sores, 253 

Gallic acid, 254 

Iodoform, gr. 20 (1.3), with oil of eucalyp- 
tus, oz. ^ (16.0), or iodoform, oz. \ (16.0), 
camphor, gr. 75 (5.0), and essence of 
roses, gtt. 2 (0.1), as a dressing for syph- 
ilitic sores, 288 

Petrolatum, as an emollient dressing, 378 

Potassium permanganate (gr. 60 to the pint 
[4.0:480.0]), as a wash, 377 

Quercus, powdered, as a poultice, to check 
discharge, 398 

Red or yellow oxide of mercmy a good 
dressing for syphilitic sores, 332 

Sulphuric acid, sometimes used as an 
escharotic in venereal sores, 434 

Zinc-oxide ointment, 368 

SORE-THROAT. 

Aconite, in early stage, 62 

Alum (gr. 20 to the ounce [1.3:30.0]), 

locally applied on swab, 75 
Arsenic, 103 
Belladonna, of greatest service in some 

cases, 118 
Capsicum, tincture of, and glycerin, 150 
Copper sulphate (gr. 4 to the ounce [0.25: 

30.0]), often of service in relaxed sore 

throat, 218 
Gambir, as a gargle or in troches, 255 
Guaiac. 262 

Hamamelis, in relaxed sore throat, 265 
Hydrogen peroxide (2 per cent, strength), 

in spray, in foetid types, 274 
Kino, as a gargle, 302 
Myrrh, tincture of, diluted one-half, as a 

gargle in ulcerated types, 338 
Phenol (1 :100J, in spray, in ulcerated tvpes, 

154 
Potassium chlorate gargle in anginose form, 

prescription for, 167 
Quercus, useful as a gargle, 398 
Quinine (gr. 1 to 2 to the ounce [0.06-0.12 : 

30.0]), in spray, in foetid sore throat,. 

194 
Rhus glabra, with glycerin and water, use- 
ful as a gargle, 401 

SPASMS. 

Belladonna, useful in urethral, anal, and 

vesical spasm, 116 
Bromides in spasmodic contractions, 127 
Cannabis indica, useful in vesical spasm, 

146 
Conium, useful, if due to irritation of 

nerve-trunk, 214 
Ether, inhalation, relieves local spasms, 

243 
Gelsemium in localized muscular spasms, 

257 
Hyoscyamus in local spasm or where pain 

is due to spasm, 275 
Nitrite of amyl, of service to relax, 84 



INDEX OF DISEASES AND REMEDIES. 



905 



SPERMATORRHOEA. (See Emissions.) 

SPRAINS. 

Arnica, 99 

Camphor liniment, 143 

Cold applications, useful in sprained ankle, 

471 
Croton-oil liniment, 222 
Hot bath, very useful in sprained ankle, 

504 
Hot-air bath, 510 
Ichthyol ointment, well rubbed in, very 

useful, 278 
Lead- water and laudanum, 307, 363 
Soap liniment, 419 
Soap plaster, used as a support to sprained 

joints, 420 
Soluble glass, 419 
Turpentine liniment, 452 
Warming plaster, 393 

STINGS AND BITES, 794 

Alcohol in snake-bite, 66 

Ammonia or alkaline liquids, locally ap- 
plied to neutralize poison, 79, 794 

Antivenine, 795 

Corrosive sublimate, with flexible collodion 
(1:1000), painted over part; salicylic 
acid a useful addition, 794 

Hydrogen peroxide applied locally to 
hornet's sting, of great value, 274 

Ipecac paste for stings of bees, 292 

Ligature, or cleansing of wound, at once, 
to prevent absorption in snake-bite, 
795 

Phenol (1:50 or 100), sponged over part, 
useful in mosquito-bites, 794 

Potassium permanganate, applied and in- 
jected around snake-bite, followed by 
alcohol in full dose, 377, 795 

Vinegar, dilute or pure, locally applied, 
often relieves insect-bites, 794 

STOMATITIS, 795 

Borax, as a mouth-wash, prescription for, 

123, 795 
Bromide of potassium or sodium, gr. 1 to 10 

(0.06-0.60), thrice daily, when nervous 

irritability is excessive, 796 
Cleansing nipples, in breast-fed babies, 796 
Cocaine, before cauterization, 201 
Nitrate of silver, stick touched to sore 

spots when thev fail to yield to other 

treatment, 343/796 
Nitric acid, V\ 3 (0.20), in water, taken 

through tube, 345 
Nitro-muriatic acid, indicated when hepatic 

torpor exists, 796 
Peroxide of hydrogen, 795 
Phenol, as a mouth- wash, 154 
Potassium chlorate, prescription for, 168, 

795 
Salicylic acid (1:250), as a mouth-wash, 

after blisters have broken, to allay pain, 

406 
Salines or rhubarb, if constipation exist, 

795 
Sozoiodol (5 per cent, solution), locally 

applied, 424 



Sweet spirit of nitre, 10 minims (0.60), well 
diluted, to a one- or two-year-old child, 
and a warm foot-bath, before retiring, 
to produce rest, 796 

Thymol, prescription for, 445 

Tonics and careful diet after the attack, 
796 

STYES, 796 

Boric acid (saturated solution), collodion 
(ethereal solution), or red or yellow 
oxide of mercury salve (gr. 2 to the 
ounce [0.12-30.0]), locally applied to 
abort, 796 

Calcium sulphate, if they tend to return, 
796 

Hot compresses, to alleviate pain, 796 

Incision, as soon as pus forms, 796 

Tonics, if general health is poor, 796 

SUBINVOLUTION OF UTERUS. (See In- 
volution, Anomalies of.) 

SUNBURN. 

Almonds, in emulsion, 72 

Carbonate of lead, prescription for, 307 

SUNSTROKE, 796 

Antipyretics, almost useless, 93, 797 

Hot baths (105° to 110° F.), or hot bottles 
or bricks, in heat exhaustion, 798 

Ice, application to chest, back, and abdo- 
men, as quickly as possible, in thermic 
fever, 487, 797 

Salicylic acid, quinine, and similar drugs 
contraindicated, 798 

Tonics, during convalescence in heat ex- 
haustion, 798 

Venesection, best treatment, if face be 
cyanotic and heart laboring, and if 
meningitis threatens, after thermic fever, 
797 

Veratrum may be used if meningitis 
threatens, 797 

SYNCOPE. 

Ammonia, if due to shock or indigestion, 78 

SYNOVITIS. 

Counterirritation, 492 
Iodine, 285 

Phenol (2 per cent, strength), as an injec- 
tion in chronic types, 154 

SYPHILIS, 798 

Biniodide of mercury, 327 

Bismuth and calomel, as a dusting-powder, 
or bichloride solution (1:2000), locally 
applied to mucous patches about geni- 
talia, 800 

Calomel hypodermically, 328 

Calomel, gr. % (0.01), every two hours for 
cephalalgia, 800 

Cod-liver oil, useful in advanced cases, 208, 
803 

Europhen, gr. 1 to 3 (0.06-0.20), internally, 
252 

Expectant plan of treatment, 799 



906 



INDEX OF DISEASES AND REMEDIES. 



Folmaldehyde solution, useful for cauter- 
izing sores, 252 

Guaiac not used at present, 262 

Hvpodermic injections of mercury, 325, 
328, 330, 802 

Iodides, followed if necessary by mercury, 
recommended by some, 279, 799 

Iodoform, gr. 1 to 5 (0.06-0.30), internally 
in tertiary stage, and the ointment 
applied to ulcers, very useful, 288, 803 

Iodol, in tertiary stage, 289 

Mercurial ointment, by inunction, 331, 802 

Mercurv by fumigation, general and local, 
319, "801 

Mercurv, at beginning of secondarv stage, 
followed later by the iodides, 799, 800 

Mercury, with chalk, chiefly employed in 
infantile svphilis, 330 

Mixed treatment, 800, 801 

Ointments and washes of mercury, and hot 
applications, to combat surface erup- 
tions, 800 

Prescription for potassium iodide and mer- 
cury, to be used after first eighteen 
months, 801 

Prescriptions for blue mass and iron, 801 

Pressure bandage and mercurial inunctions 
for periostitis, 801 

Protiodide of mercury, 332, 800 

Salicylate of mercury hypodermically, 333 

Sarsaparilla, a useful adjunct to potassium 
iodide, 413, 803 

Shampooing and local application of croton 
oil, or cantharides, as a lotion, to com- 
bat alopecia, 800 

Silver nitrate, copper sulphate, chromic- 
acid solution (20 per cent.) or acid nitrate 
of mercury, locally applied to mucous 
patches, in mouth, 800 

Stillingia, used as an aid to other drugs, 
427 

Thiol, in syphilides, 443 

Tonic and general treatment, 803 

Vapor baths, hypodermic injections, or 
inunctions, useful modes of applying 
mercury if it cannot be taken bv mouth, 
801 

SYSTEMIC STRAIN. 

Opium, useful in prolonged physical strain, 
363, 364 

Quinine, gr. 2 to 4 (0.12-0.25), useful to 
prevent exhaustion following physical 
and mental strain, 192 

TABES DORSALIS. (See Locomotor 
Ataxia.) 
Chloralformamide, prescription for, 166 

TAPE-WORM. (See Worms.) 

TEETHING. 

Bromide of potassium, to prevent convul- 
sions, 127 

TETANUS, 803. (See Poisoning from 
Strychnine.) 
Amyl nitrite, to relieve and prevent, 84 
Antitoxin, value of, not established, 803 
Chloral and bromide of potassium, by 

mouth or rectum, 164 



Fowler's solution, said to be almost specific 

in some cases, 803 
Hot pack may be used, 509 
Physostigma, of moderate value, 386 

TINEA CAPITIS. 

Lime-water, locally applied, 141 

TINEA CIRCINATA, 785 
Borax, strong solution, locally applied, 123 
Iodine, applied with camel 's-hair brush, 

285, 785 
Turpentine, useful, applied with a brush, 
452 

TINEA TARSI. 
Copper, crystals, or weak solution, applied 
to diseased eyelid, 218 

TINEA TONSURANS. 

Anthrarobin as a wash, 85 
Borax, strong solution, locally applied, 123 
Iodine, applied with camel's-hair brush, 285 
Oil of cajuput, applied pure, 137 

TOE-NAILS (IN-GROWING). 

Absorbent cotton, soaked in strong alum 

solution, and inserted under nail, 76 
Liquor potassii hydroxidi, to soften nail 

prior to packing with cotton or partial 

evulsion, 310 
Phenol to produce local anaesthesia in 

e version of, 154 

TONSILLITIS, 803 

Alum stick, deeply applied, 76 
Ammonium iodide, for enlarged tonsils, 82 
Bichloride of mercury, gr. -^ts (0.0003) 

every hour in water for 4 or 5 hours to 

abort, 327, 804 
Corrosive sublimate when inflammation is 

severe, 326 
Glycerin and tincture of capsicum, equal 

parts, applied by swab, 150 
Guaiac, 262, 804 

Guaiacol, applied locally, 263, 804 
Hot fomentations and gargles useful in 

some cases, 804 
Hydrogen peroxide (2 per cent, strength) , 

in spray, in ulcerative types, 274 
Ice-bag to throat, 804 
Iron, tincture of the chloride, 296, 804 
Monsel's solution, pure, applied with cam- 
el's-hair brush, 298 
Nitrate of silver, applied locally, 804 
Phenol, solution (1 :100), as an antiseptic 

gargle, 804 
Salicylates, are valuable in rheumatic cases, 

406, 804 
Saline purgatve, followed by fever mixture 

of aconite, sweet spirit of nitre, and 

potassium citrate, 804 
Scarification may be of service in early 

stages, 804 

TOOTHACHE. 

Chloretone dissolved in oil of cloves, ap- 
plied on cotton, 169 

Creosote, applied on cotton, often relieves, 
220 



INDEX OF DISEASES AND REMEDIES. 



907 



Oil of cloves, inserted into cavity on cot- 
ton, 199 
Oil of peppermint, applied on cotton, 375 

TORPOR. 

Acetate of potassium, in hepatic torpor, 

58 
Ammonium chloride, in hepatic torpor, 82 
Arsenic, in gastric torpor, 103 
Citric acid, in hepatic torpor, ] 98 
Euonymus, in mild hepatic torpor, 250 
Lactophosphates and hypophosphites, use- 
ful in hepatic torpor, 139 
Nitro-hydrochloric acid, in torpor of liver, 

348 
Russian and Turkish baths, useful in tor- 
pidity of skin and kidneys, 506 
Taraxacum, in hepatic torpor, 440 

TORTICOLLIS. 

Belladonna, injected into muscles, 116 
Gelsemium, 257 
Hot compresses, 505 



TREMOR. 



Hyoscine, 276 
Sparteine, 416 



TUBERCULOSIS, 804 

Acetanilid, generally acts unfavorably, 56 

Agaricin. of doubtful value in night-sweats, 
63 

Almonds, essential oil of, recommended in 
cough, 72 

Alum (gr. 10 to 20 to the ounce [0.60-1.3: 
30.0]), or sulphuric acid (1 drachm to 
the pint [4.0:480]), useful, sponged over 
body in night-sweats, 808 

Antipyrin harmful, 93 

Arsenic, in phthisis, and in phthisical ten- 
dencies, 101, 103 

Atropine, gr. ^ to T fo (0.0012-0.0006), 
hypodermic ally, in excessive night- 
sweats, 808 

Blister, small, useful over new pleuritic 
spots, 807 

Cacodylate of iron in albumimiria of, 295 

Camphoric acid, gr. 20 to 30 (1.3-2.0), in- 
valuable, 144, 808 

Cannabis indica. 145, 807 

Chloride of calcium, 138 

Chloroform, spirit of, used by inhaler, often 
relieves cough, 807 

Cinnamic acid hypodermically and intra- 
muscularly, 198 

Climatic treatment, 533 

Codeine, recommended in excessive cough, 
207 

Cod-liver oil, rules for its use, 209, 806 

Copper in tubercular tendencies, 217 

Creosotal as an expectorant, 221 

Creosote, internally, in spray or by inhaler, 
often relieves cough and discomfort; 
contraindicated if fever and haemoptysis 
are present; prescription for, 218, 806 

•Glycerin and water equal parts, with lemon 
juice, useful as a mouth-wash, 260 

Guaiacol carbonate more readily borne by 
the stomach than guaiacol, 264 



Guaiacol. useful in, 262. 263 

Heroin useful to stop cough, 807 

Hygienic measures, 805 

Inhalations of steam from corrosive subli- 
mate solution (1 :10,000), stopping at 
first sign of mercurial effects, in laryn- 
geal phthisis, precede inhalation with 
cocaine-spray (4 per cent, solution), 807 

Iodine, useful, painted over new pleuritic 
spots, also useful in chrome cases as an 
inhalant, 285, 286, 807 

Iodoform emulsion (10 per cent.), useful 
in tubercular abscess, 288 

Iodoform with small amount of powdered 
talc and a little morphine, useful when 
puffed into the larynx in laryngeal tuber- 
culosis, 808 ; also used in spray, 288 

Iodol, of use in tubercular laryngitis, 289 

Lactic-acid applications (10 to 60 per cent, 
solution), in laryngeal tuberculosis, vising 
cocaine-spray first to relieve pain, 807 

Lactophosphates and hypophosphites, 139 

Morphine and wild-cherry bark in cough, 
prescription for, 807 

Nuclein, 351 

Oil of cloves, 199 

Opium, may be given in last stage, to re- 
lieve pain and discomfort, 364 

Oxygen, inhalations in dyspnoea, 370 

Phenol (TTl 5 to 15 to the ounce [0.3- 
1.0:30.0]), in spray, 153 

Pilocarpine, gr. ^ (0.003), one to two hours 
before sweat, sometimes arrests; if it or 
atropine fails alone, give them together, 
808 

Potassium cyanide, in excessive cough, 
prescription for, 223 

Silver nitrate (gr. -h to 2 to the ounce [0.03- 
0.12:30.0]), in spray, may be tried in 
laryngeal types, 343 

Sodium cacodylate in anaemia, 421 

Strychnine in d\'spnoea, 354 

Sulphuric acid, . internally, may relieve 
night-sweats, 808 

Terebene, iodide of ethyl, and chloroform, 
equal parts, for inhalation, 807 

Thiocol as a substitute for creosote, 443 

TYPHOID FEVER, 808. (See Fever.) 

Acetanilid, generally acts unfavorably, 56 

Alcohol, useful throughout course of dis- 
ease, 67, 809 

Asafoetida, by rectal injections, in tympa- 
nites, 110 

Belladonna in cases of collapse or vaso- 
motor relaxation, 117 

Calomel, gr. ^ (0.001), every fifteen min- 
utes, till gr. 1 (0.06) is taken, followed 
by magnesium sulphate, •§- ounce (16.0), 
if constipation lasts two days, 379, 811 

Cascara sagrada for constipation, 811 

Enemas, to be tried first, if constipation 
lasts over two days, 811 

Glycerin and water, equal parts, with a 
little lemon-juice, as a mouth-wash, if 
sores are present, 260, 811 

Guaiacol carbonate, an intestinal anti- 
septic of value, 264, 811 

Guaiacol, an antipyretic in, 263 



908 



INDEX OF DISEASES AND REMEDIES. 



Hydrochloric acid, dilute, Vf[ 5 (0.3) every 
few hours, or, if bowels are inactive, 
nitrohvdrochloric acid. TT\ 3 (0.15), 271, 
811 

Hvpodermoclysis, if toxaemia is marked, 
812 

Lime-water added to milk, if vomiting 
threatens, 811 

liquorice powder, drachm 1 (4.0) if con- 
stipation lasts over two days, 811 

Milk diet, 809, 811 

Morphine in large dose, if perforation oc- 
curs, 812 

Opium for insomnia, 362 

Phenolsulphonate of zinc, useful, 381 

Phosphorus, if nervous system is affected, 
384 

Prescription for diarrhoea, 811 

Quinine inferior to new antipyretics, 193 

Reduction of fever by cold, 485 

Rest and diet, 809, 810 

Silver nitrate, gr. * to £ (0.01-0.015), 
highly recommended, 342 

Sponging with tepid water and alcohol, 
with friction, of value when toxaemia is 
marked, 812 

Thymol as an intestinal antiseptic, 444 

Turpentine, in the form of stupes, enemata, 
or by mouth, in tympanites, also useful 
in later stage, to relieve diarrhoea, heal 
ulcers, and prevent relapse, 450, 811 

Urotropin (hexamethylenamine) to render 
the urine sterile, 452. (For remedies for 
complications — intestinal hemorrhage, 
pneumonia, and pleurisy — see their 
titles.) 

ULCERS. 

Aristol, 445 

Benzoate of bismuth, as a dressing for in- 
dolent or sloughing ulcers, 121 

Burnt alum, as a dressing for old ulcers, 76 

Caustic potash, as an escharotic for exu- 
berant ulcers, 159 

Chimaphilia, said to be of service in stru- 
mous ulcers, 160 

Chloretone with equal parts of boric acid, 
as an antiseptic dressing, 169 

Conium, used locally to relieve pain, 215 

Copper, in solid or powder form, locally 
applied to indolent ulcers, 218 

Creolin, solution (1:100), as a douche for 
nasal ulcers, 221 

Dried alum, useful, 76 

Europhen, in 10 per cent, ointment, in leg 
ulcers, 251 

Gallic-acid ointment, in actively discharg- 
ing ulcers, 254 

Glutol as an antiseptic powder, 254 

Hamamelis, locally applied on a cloth, 
relieves leg ulcers, 265 

Hot pack, to increase activity of skin, 509 

Hydrogen peroxide, a useful application, 274 

Lime, as an escharotic in old ulcers, 140 

Methyl blue in corneal ulcers, 334 

Nargol ointment, 5 to 10 per cent., in sup- 
purating ulcers, 340 

Nitric acid, as a caustic for phagedenic 
ulcers, or a solution (n\ 5 to 30 to the 
ounce [0.3-2.0:30.0]), locally applied to 
indolent types, 344, 345 



Ointment of lead carbonate as a dressing, 

307 
Potassium permanganate (gr. 60 to the pint 

[4.0:500]), as an antiseptic wash, 377 
Precipitated carbonate of calcium, as a dry 

dressing, 137 
Silver nitrate, by injection for rectal and 

caecal ulcers, 342 
Sulphuric acid, sometimes used as an 

escharotic in slow ulcers, 434 
Tannic acid, useful locally, in indolent 

ulcers, 439 
Unna's dressing, 368 

URiEMIA, 813 

Atropine useful in pulmonary oedema, 814 

Bromides for convulsions, 814 

Caffeine useful to stimulate the kidneys, 

814 
Chloral and chloroform for convulsions, 814 
Elaterium or elate rin to aid elimination of 

poison by the bowel, 233, 813 
Ether given by the mouth or hypodermic- 
ally, 243, 814 
Heroin for dyspnoea, 266 
Hot pack, 813 
Hypodermoclysis, 513, 814 
Nitroglycerin to increase the urinary flow 

when arterial tension is high, 814 
Pilocarpine, gr. &, with strychnine, gr. -£$, 

to increase action of the skin, 389, 813 
Strychnine, followed by digitalis for heart 

failure, 814 
Transfusion of salt solution of great value,. 

538, 814 
Venesection, very useful, 814 

URIC- ACID DIATHESIS. 

Acetate of potassium, 58 
Lime-water, 140 

Piperazine in the dose of 15 grains (1.0) a 
day in 1 pint (480) of water, 391 

URTICARIA. 

Calcium chloride, to prevent, 138 

UTERINE INERTIA. 

Kola useful, 303 

Quinine not of great value, 194 

UVULA (RELAXED). 

Capsicum, tincture of, and glycerin, equal 

parts, as a gargle, 150 
Kino, as a gargle, 302 

VARICOCELE. 

Cold water, applied by bidet, highly recom- 
mended, 476 

VARICOSE VEINS. 

Barium chloride, internally and locally 
applied, said to be of value, 112 

VITREOUS DISEASES, 814 

Antisyphilitic treatment, if due to syphilis, 
814 

Galvanism, 814 



INDEX OF DISEASES AND REMEDIES. 



909 



Leeches, in earl}' stage, if due to inflam- 
mation, 814 
Pilocarpine, hvpodermicallv, in opacities, 
389, 814 

VOMITING, 815 
Acetanilid, very useful, 57, 816 
Allium-juice, 17] 2 to 5 (0.10-0.3), useful in 

nervous vomiting, 71 
Arsenic in vomiting of pregnancy, and of 
hand-fed babies, and of drunkards, 103, 
S17 
Bismuth and aconite may be of service, 

prescription for, 120, 816 
Brandy poured on cracked ice very useful, 

67, 816 
Bromide of potassium, effervescing, 128 
Bromide of sodium, with laudanum as a 

rectal injection, prescription for, 129, 

362, 816 
Calomel, 329 
Chloretone, if due to irritation, and after 

etherization, 168, 816 
Chloroform, T7U to 2 (0.05-0.1), in water,817 
Cloves, oil of, sometimes controls, 199 
Cocaine or aconite, if clue to hyperexcita- 

bility of stomach, 205, 816 
Enemas, partially digested, if vomiting is 

incoercible, 818 
Faradism sometimes gives relief, 817 
Fowler's solution, gtt. -^ to 1 (0.025-0.05), 

every two hours, useful in nausea follow- 
ing debauch, 68, 817 
Hydrochloric acid, HI 5 to 15 (0.3-1.0), in 

water, every two hours, in alcoholic 

nausea, 271, 817 
Hvdrocyanic acid, dilute, Vf[ 2 to 6 (0.1- 

0.4), in water, 272, 817 
Ice-bag to nape of neck, lumbar region, or 

epigastrium, 817 
Iodine and phenol, TT\ 1 (0.05) of each in dr. 

2 (8.0) of water, 816 
Ipecac, in small doses, if due to gastric 

depression, 291, 817 
Lime-water, added to milk, may relieve 

nausea, 140, 818 
Mustard plaster over stomach, useful in all 

cases, 817 
Nitroglycerin, very useful in some cases, 

347, 817 
Nux vomica, if due to- gastric depression, 

prescription for, 817 
Opium when excessive, 362 
Peptonized milk, best food, 818 
Phenol or creosote, with bismuth, useful 

in acidity and fermentation, prescription 

for, 153, '806 
Podophyllin, useful in gastric depression 

and hepatic torpor, 393 
Seidlitz powder, often settles stomach, if 

due to constipation, 416 
Vinegar fumes of service when inhaled, 59, 

816 

VOMITING OF PREGNANCY. 

Aconite, as a nervous sedative, 62 

Arsenic, may be tried, 103 

Bromide of potassium, as an effervescing 
draught, or with opium, by enema, pre- 
scriptions for, 128 



Cerium oxalate, gr. 2 to 5 (0.12-0.30), in 
pill, every four or five hours, 160 

Cocaine, useful to decrease irritability, 205 

Iodine, tincture of, largely used of late with 
good results, 287 

Ipecac wine, 171 1 (0.05), or powder, gr. 2 
(0.1), useful in some cases, 291 

Menthol, very useful, 375 

WARTS. 

Acetic and salicylic acids combined, 59 
Chromic acid (gr. 100 to the ounce [6.6: 

30.0]), locally applied, to remove, 188 
Fowler's solution, locally applied, 104 
Glacial acetic acid, useful to remove, 59 
Mercuric nitrate solution locally, 332 
Nitric acid, as a caustic, 344 
Sulphuric acid locally, 434 
Trichloracetic acid, useful, 448 

WHOOPING-COUGH, 818 

Amber, oil of, 77 

Amyl nitrite, when paroxysms interfere 
with respiration, 84, 818 

Antipyrin, gr. + to 3 (0.03-0.20), every 
five hours, probably the best remedy, 94, 
818 

Belladonna, tincture of, Vf[ 2 (0.10), twice 
a dav. to child of one or two vears, 116, 
818 

Benzine, 819 

Bromoform, prescription for, 132, 819 

Bronchitis tent, to modify severity of at- 
tacks, 819 

Carburetted hydrogen, 818 

Chloral, 165 

Chloride of gold and sodium has been 
recommended, 261 

Chloroform, a few whiffs, if paroxysms in- 
terfere with respiration, 179, 818 

Creosote, on wet cloths hung in the nursery, 
of value, 220 

Gelsemium, 257 

Hyoscyamus, probably better than bella- 
donna, 275 

Milk, in small amounts, ma}" overcome 
vomiting following paroxysms, 819 

Monobromated camphor, 144 

Potassium bromide, in 127 

Quinine (gr. 1 to the ounce [0.06:30.0]), in 
spray, useful, also of service in exposed 
children as a prophylactic, 194, 818 

Resorcinol, TT1 10 (0.60), of a 2 per cent, solu- 
tion, internally, or, better, in spray, 399 

Silver nitrate (gr. J to 1 to the ounce [0.03- 
0.06 :30.0]), in spray, used when stomach 
is empty, 343 

Zinc oxide, 369 

WORMS, 819 

Aspidium, very efficient against tape-worm, 
prescription for, 110, 820 

Azedarach, a useful remedy against round- 
worms, 111 

Brayera, as an infusion, or fluid extract, 
against round-worms, 820 

Calomel, should follow or precede all drugs 
used for tape-worm, 820 



910 



INDEX OF DISEASES AND REMEDIES. 



Castor oil, or a saline purgative, should fol- 
low remedies for round-worms, 820 

Chenopodium, oil of, 111 5 to 20 (0.3-1.3), 
on sugar to remove round-worms, 161, 
820 

Chloroform, should not be used against 
tape- worm, 183 

Cusso in tape-worm, 223 

Kamala, drachms 1 to 2 (4.0-8.0), in syrup, 
against tape-worms, 302 

Koosin, gr. 40 (2.6), to adult, against 
round-worms, contraindicated in preg- 
nant women, 820 

Matricaria, 316 

Pelletierine, gr. 3 to 5 (0.20-0.30), in cap- 
sule, best remedy against tape-worm, 820 

Pepo, ounce 2 (60.0), in confection, against 
tape-worm, 373, 820 

Pomegranate, useful in tape-worm, 394, 
820 

Quassia injections, preceded by soap and 
water, most useful remedy against seat- 
worms, 397, 820 

Rue, should not be used against round- 
worms, 403 

Rules for diet preceding taeniacides,, 819 

Salicylic acid; gr. 8 (0.5), hourly till gr. 40 
(2.6) are taken, against round-worms, 
or as an injection against seat-worms, 
prescription for, 407 

Santonin, gr. \ to \ (0.015-0.03), in troches, 
for child, against round-worms, 412, 820 



Spigelia, alone, or, better, with senna, to 
remove round-worms, 424, 819 

Thymol, gr. 2 to 4 (0.12-0.25) in capsule, 
once a day, for removal of anchylostoma 
duodenale, 820 

Turpentine and castor oil, equal parts, effi- 
cient, but somewhat dangerous, against 
tape- worm, 451 

WOUNDS. 

Acetanilid, as a dusting-powder, 57 
Alcohol, very useful in contused wounds, 

67 
Chloretone, with equal parts boric acid, as- 

an antiseptic dressing, 169 
Collodion, as an air-tight dressing for small 

wounds, 212 
Glutol, as an antiseptic powder, 253 
Oil of cinnamon, 197 
Orthoform as an antiseptic, 367 
Potassium permanganate (gr. 20 to 60 to 

the pint [1.3-4.0:480]), as an antiseptic 

wash, 377 
Salicylic acid, 407 
Sozoiodol, as an antiseptic and disinfectant 

in diseased wounds, 424 
Thymol, locally, 445 

YELLOW-FEVER. 

Cocaine of great value as a stimulant and 
anti-emetic, 204 



